Citation Nr: 21061782 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-08 241 DATE: October 5, 2021 REMANDED Entitlement to service connection for low back disorder, including degenerative disc disease (DDD), is remanded. REASONS FOR REMAND On the last review of this case the Board remanded it to the Agency of Original Jurisdiction (AOJ) for additional development due to noncompliance with a remand. See 02/10/2021 BVA Decision. The Board again finds less than substantial compliance with the remand directive. See Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for low back disorder, including DDD, is remanded. In the last remand the Board noted that the January 2020 VA examiner noted a 1991 x-ray examination report which the Board could not find in the claims file. Hence, the Board directed that he examiner to provide the exact location in the claims file where he found the x-ray examination report. The Board notes that the June 2021 report that contains a medical opinion (06/10/2021 C&P Exam, 2nd Entry, P. 2, Block 2A). On the other hand, the AOJ examination request does not repeat the Board's remand directive. See 06/29/2021 Exam Request. In any event, the examiner did not indicate the exact location where he purportedly found the report; he merely quoted what the report notes. The main failing is that the examiner did not comply with the Board's remand directive. The examiner did not indicate that he considered the Veteran's lay report of his history or the other lay evidence of record. Further, neither did the examiner explain the relevance, if any, of the absence of medical documentation. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Board notes that the examiner cited medical studies and treatises that address the nature of low back pain and the impact of aging, but that does not address the Board's specific directives. As matters stand, the sole underlying basis for the examiner's negative nexus opinion is that there are no treatment records related to the Veteran's low back until many years after his separation from active service. Absent an explanation of the relevance of this fact, if any, the examiner's opinion is inadequate. The matters are REMANDED for the following action: The issue is still whether it is at least as likely as not (at least a 50 percent probability) that the Veteran's currently diagnosed low back disorder, including lumbar spine DDD, had onset in active service or is otherwise causally connected to active service. The Board reminds the AOJ that the AOJ is responsible for faithfully conveying the Board's remand directives to a medical examiner. Send the claims file to the clinician who provided the addendums to the January 2020 VA spine examination, or an equally or higher qualified clinician. Ask the clinician again to identify the exact location in the claims file where the referenced May 1991 lumbar spine x-ray examination is located. Inform the clinician that if the cited report is not found in the claims file, it will not be considered in support of any medical opinion provided. Inform the clinician again that the lay evidence of record must be considered, and that the Board has not yet made a determination on the reliability and accuracy of the lay evidence of record. Hence, the clinician must address whether the lay evidence of an in-service, shipboard lifting injury was considered in arriving at the nexus opinions. If the absence of treatment records is significant, then the significance must be explained, as the absence of contemporaneous medical documentation, alone, is not a sufficient reason for rejecting lay evidence. Buchanan, 451 F.3d at 1337. As concerns the medical treatise information noted by the clinician in the June 2021 and July 2021 reports, the clinician must explain their significance as it applies to the Veteran's individual case. A full and complete rationale will encompass and address all of the above factors. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. T. Snyder 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.