Citation Nr: 21062231 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 17-43 870 DATE: October 6, 2021 REMANDED Entitlement to service connection for a lumbar spine disability, to include degenerative arthritis and degenerative disc disease (DDD), is remanded Entitlement to service connection for a cervical spine disability, to include degenerative arthritis and DDD, is remanded. Entitlement to service connection for bilateral hand tremors, to include as due to exposure to herbicide agents and/or as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran had active military service from November 1975 to July 1992, to include service in the Republic of Vietnam. The Veteran's awards and decorations include the Distinguished Flying Cross and Purple Heart Medal. This case comes before the Board of Veterans' Appeals (Board) on appeal of a September 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in January 2020, at which time the issues on appeal were remanded for further development. This case has been returned to the Board for further appellate action. Service Connection Lumbar Spine and Cervical Spine Disabilities In January 2020, the Board remanded the claims of entitlement to service connection for lumbar and cervical spine disabilities for additional development. At that time, the Board directed that the Veteran be afforded a VA examination to determine the nature and etiology of his lumbar and cervical spine disabilities. A review of the record shows that the Veteran was afforded the directed VA examinations in March 2020. At that time, the VA examiner opined that the Veteran's lumbar and cervical spine disabilities were less likely that not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner noted an October 1983 X-ray revealed a preexisting adolescent condition of Scheuermann's disease. However, the VA examiner reasoned that there was no documented medical or diagnostic evidence to support preexisting thoracic and lumbar spine conditions being aggravated beyond their normal progression due to an in-service activity or injury. Further, the examiner noted that the Veteran did not report a history of neck pain during his retirement examination or general compensation and pension (C&P) examination. Additionally, the VA examiner reasoned that the Veteran's November 2005 finding of DDD of the cervical spine was not unusual for his age of 54 years old, combined with his 30-year history of tobacco use. The Board finds that the March 2020 medical opinions, pertaining to the lumbar and cervical spine disabilities, are inadequate for adjudication purposes. In this regard, the examiner's negative etiological opinion based on a lack of service treatment records, and the examiner failed to specifically address the Veteran's lay statements pertaining to the onset and continuation of his symptoms. Specifically, the Veteran's assertions that his back injuries resulted from an improper landing and helicopter crash; and, that his cervical spine injury was diagnosed and treated as tendonitis. Therefore, the Board finds that the development conducted does not adequately comply with the January 2020 Board remand directives. Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, additional VA medical opinions should be obtained to determine the nature and etiology of the Veteran's lumbar and cervical spine disabilities. Service Connection Hand Tremors In January 2020, the Board remanded the claim of entitlement to service connection for hand tremors for additional development. At that time, the Board directed that the Veteran be afforded a VA examination to determine the nature and etiology of his hand tremors. A review of the record shows that the Veteran was afforded the directed VA examination in March 2020. At that time, the VA examiner opined that there was no documented medical evidence to support a diagnosis of tremors in service, nor presently. The VA examiner noted that the Veteran had provided a written statement, but that there was no documentation from a medical provider, neurologist or specialist to support a diagnosis or treatment of tremors. The Board finds that the March 2020 opinion is inadequate for adjudication purposes. In this regard, the VA examiner's opinion is based on an inaccurate premise. Specifically, the VA examiner failed to accurately document that the Veteran was seen by a neurologist for his diagnosis of essential tremors. Additionally, the VA examiner did not document the May 2014 objective report of tremors by a medical professional or the notations of tremors with increased anxiety in his psychiatry notes. Therefore, the Board finds that the development conducted does not adequately comply with the January 2020 Board remand directives. Compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, an additional VA medical opinion should be obtained to determine the nature and etiology of the Veteran's hand tremors. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding private treatment records, in particular the identified non-VA neurological records, and associate them with the claims file. 2. Forward the claims file to a VA examiner who has not previously examined the Veteran or provided an opinion in the appeal for an addendum medical opinion regarding the nature and etiology of the Veteran's lumbar and cervical spine disabilities. The examiner must review the claims file, and note that review in the report. Based on a thorough review of the record, the examiner must provide an opinion as to whether a lumbar spine disability, to include Scheuermann's disease, clearly and unmistakably existed prior to the Veteran's active service, and if so, was clearly and unmistakably NOT aggravated by service. For any back disability that did NOT exist prior to the Veteran's active service, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that such disability was incurred in, or is otherwise related to his active service, to specifically include the Veteran's reported back injuries during an improper landing after a jump from 15 to 20 feet; AND after a helicopter crash. The examiner MUST specifically address the October 1983 X-ray evidence of wedging at T11, T12, and T8. The examiner must also provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's current cervical spine disability was incurred in, or is otherwise related to his active service? The examiner MUST specifically address the Veteran's assertions of left arm pain during service, and any potential association with left arm pain and a diagnosis of a pinched nerve in the cervical vertebrae. A complete and detailed rationale must be provided for all opinions expressed. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinions. 3. Forward the claims file to a VA examiner with appropriate expertise for an addendum medical opinion regarding the nature and etiology of the Veteran's diagnosed hand tremors. The examiner must review the claims file, and note that review in the report. Based on a thorough review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's hand tremors are caused or aggravated (chronically worsened) by a service-connected disability, to specifically include PTSD. In forming the opinion, the examiner must consider the Veteran's lay statements regarding the association of his anxiety and his tremors. A complete and detailed rationale must be provided for all opinions expressed. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinions. 4. Confirm that all medical opinions provided comport with this remand, and undertake any other development determined to be warranted. (Continued on the next page) 5. Then, readjudicate the appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Byrd, Associate 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.