Citation Nr: 21061685 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 14-34 900 DATE: October 5, 2021 REMANDED Entitlement to service connection for degenerative joint disease of the low back is remanded. Entitlement to service connection for neuropathy of the left leg (also claimed as nerve damage, left leg) as secondary to degenerative joint disease of the low back is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from October 1972 to October 1974, from January 1976 to January 1979, and from March 1990 to May 2005. This appeal comes before the Board of Veterans' Appeals (Board) from an August 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). These matters have previously come before the Board. In a November 2019 Memorandum Decision, the United States Court of Appeals for Veterans Claims (Court) vacated a May 2018 Board decision denying the instant claims. In May 2020 and October 2020, the Board remanded for additional medical opinions consistent with the Court's opinion. Specifically, the Board instructed that an orthopedic surgeon should address whether the Veteran's lower back degeneration was the result of wear and tear over a 20-year military career, and whether the degenerative process likely began within one year of the Veteran's discharge in May 2005. In April 2021, the Board found that the opinions of record were adequate with regards to direct service connected and further remanded the claims for an opinion on whether the Veteran's low back degeneration was secondary to his service-connected knee condition. Unfortunately, the Board finds that there has not been substantial compliance with the Board's previous remand directives regarding an opinion for secondary service connection. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for degenerative joint disease of the low back is remanded. As noted in the Board's April 2021 remand, the Veteran reasonably raised an argument for secondary service connection when he asserted in October 2011 that he sought treatment for back pain "caused by his service-connected knee disability." See Brief for Appellant, within 4/08/2020 CAVC Decision file, at 22-23. The Veteran was afforded a VA examination in June 2021, where the examiner, a doctor of occupational medicine, opined that "based on review of the provided medical records, there is no evidence documenting that the Veteran's knee condition directly or indirectly caused his lumbar degenerative disc disease. Furthermore, there is no plausible pathophysiologic mechanism discussed in the medical literature and known medical principles that would explain such a causal relationship between these conditions." The agency of original jurisdiction (AOJ) deemed this opinion inadequate because the examiner did not address whether the Veteran's low back condition was proximately due to or aggravated by his service-connected knee condition. In a July 2021 addendum opinion by the same examiner, he opined that based on review of the provided medical records, there is no evidence documenting that the Veteran's knee condition directly or indirectly caused his lumbar degenerative disc disease. Furthermore, there is no plausible pathophysiologic mechanism discussed in the medical literature and known medical principles that would explain such a causal relationship between these conditions. Therefore, the claimed condition is less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran's service-connected condition. The Board deems this opinion inadequate for adjudicative purposes as a mere statement that the low back condition is not proximately due to his service-connected knee condition is conclusory and does not rise to the level of sufficiency in detail necessary for the Board to evaluate the Veteran's condition. An opinion is adequate where it is based upon consideration of the Veteran's prior medical history and examinations and also describes the disability in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one. D'Aries v. Peake, 22 Vet. App. 97, 104 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007) (an adequate medical examination must provide a rationale and explanation for its conclusions). It is a medical examiner's responsibility to provide a well-supported opinion so that the Board may carry out its duty to weigh the evidence of record. See NievesRodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (concluding that medical opinion is not entitled to any weight "if it contains only data and conclusions"). In addition, the examiner did not address whether the Veteran's service-connected knee condition aggravated his low back condition. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995); El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (holding that medical opinion that only addresses whether a service-connected disability caused a nonservice-connected disability does not address whether the service-connected disability aggravated a nonservice-connected disability). Accordingly, the Board concludes that the Veteran should be afforded a new VA examination, by an orthopedic doctor or other suitable examiner to determine whether the Veteran's low back pain is proximately due to or aggravated by his service-connected knee condition. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the Board confers the right to compliance with remand orders). Entitlement to service connection for neuropathy of the left leg (also claimed as nerve damage, left leg) as secondary to degenerative joint disease of the low back is remanded. With respect to the Veteran's claim for left leg sciatic neuropathy, the Board finds that this claim is inextricably intertwined with his pending service connection claim for lower back degenerative joint disease. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a significant impact upon another, the two claims are inextricably intertwined). As such, the claim is remanded. These matters are REMANDED for the following actions: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, then obtain an addendum opinion from an orthopedic doctor or other qualified examiner to address secondary service connection of the Veteran's lower back degenerative joint disease. After a review of the claims file, the reviewing clinician is to address: (A) Is it at least as likely as not (50 percent or greater probability) that the Veteran's lower back degenerative joint disease is proximately due to a service-connected disability, to include but not limited to his service-connected knee disabilities? (B) Is it at least as likely as not (50 percent or greater probability) that the Veteran's lower back degenerative joint disease is aggravated beyond its natural progression by a service-connected disability, to include but not limited to his service-connected knee disabilities? If aggravation is found, please state, to the extent possible, the baseline level of disability prior to aggravation. The examiner's attention is invited to private records of treatment in September to November 2011, for concurrent knee and lower back pain. (Continued on the next page) A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Adeyemi, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.