Citation Nr: 21062494 Decision Date: 10/07/21 Archive Date: 10/07/21 DOCKET NO. 12-14 446 DATE: October 7, 2021 REMANDED Entitlement to service connection for a back disorder is remanded. REASONS FOR REMAND The appellant had a period of active duty for training (ACDUTRA) in the Texas Army National Guard from March 1990 to June 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2011 and February 2012 rating decisions. The appellant testified at a hearing before the undersigned Veterans Law Judge in July 2013. A transcript is of record. In November 2014 and July 2017, the Board reopened and remanded the appellant's claim for further development. In May 2018 and March 2019, the Board requested an advisory medical opinion from the Veterans Health Administration (VHA). In November 2019, the Board remanded the case for further development. The case has since been returned to the Board for appellate review. Although the Board regrets the additional delay, a remand is necessary to obtain an additional medical opinion that complies with the Board's prior remand directives. In a February 2020 VA medical opinion, the examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that the appellant should have been provided an examination prior to his enlistment to service in March 1990. However, the appellant's November 1988 enlistment examination report did indicate that a physical inspection was also conducted on March 1, 1990 and that the appellant was found qualified for service at that time. Moreover, the examiner did not presume that the appellant's low back disorder did not preexist his military service, as previously directed by the Board in November 2019. Stegall v. West, 11 Vet. App. 268, 271 (1998). In an August 12, 2020, VA addendum medical opinion, the examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the examiner again did not assume that the appellant's back disorder did not preexist his period of military service, as directed by the Board. Stegall v. West, 11 Vet. App. 268, 271 (1998). In an August 19, 2020 VA addendum medical opinion, the examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that the appellant's records did not document any objective complaints of back problems between his military service and a June 2003 post-service injury. However, the examiner also stated that, during an October 1990 VA examination, the appellant reported having continued back pain since lifting a heavy mop bucket during service. The Board also notes that the October 1990 VA examination report documented that the appellant's range of motion for forward flexion was limited to 50 degrees. As such, it appears that the opinion was based on an inaccurate or incomplete factual premise. For these reasons, the Board finds that a remand is necessary to obtain an additional VA medical opinion. The Board also notes that the August 2020 examiner listed a variety of questions regarding the nature of the appellant's reported in service-injury. Notably, the examiner had the opportunity to obtain details regarding the nature of the appellant's reported in-service injury during a February 2020 VA examination. Thus, on remand, if the examiner determines that additional details regarding the appellant's reported injury are required, the AOJ should ensure that the examiner obtains an additional medical history from the appellant. The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the appellant provide the names and addresses of any and all health care providers who have provided treatment for a back disorder that are not already of record. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. After completing the foregoing development, the AOJ should refer the appellant's claims file to a different examiner who is suitably qualified for a clarifying opinion as to the nature and etiology of the appellant's back disorder. An additional physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the appellant's service treatment records, post-service medical records, and assertions. He or she should specifically consider the March 2019 VHA medical opinion request that provides a summary of relevant evidence. The appellant has contended that he sustained a back injury lifting a mob bucket during his period of ACDUTRA from March 1990 to June 1990. He has also asserted that his low back pain is related to performing drills during service, including marching. It should be noted that the appellant is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should state this with a fully reasoned explanation. The examiner should assume, for the purposes of this medical opinion, that the appellant's back disorder did not preexist his period of ACDUTRA from March 1990 to June 1990. The examiner should state whether it is at least as likely as not that the appellant's back manifested in or is otherwise causally or etiologically related to his period of ACDUTRA from March 1990 to June 1990. In rendering this opinion, the examiner should address the appellant's lay statements that he had back problems since his period of ACDUTRA. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ should ensure that the medical opinion complies with the directives herein and take any corrective action if needed. 4. The AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Wulff, 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.