Citation Nr: 21062816 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 15-35 713 DATE: October 12, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a left upper extremity neurological disability is remanded. Entitlement to service connection for a right upper extremity neurological disability is remanded. INTRODUCTION The Veteran had active service from May 1965 to July 1965. In September 2017 the Veteran attended a videoconference hearing before the undersigned Veterans Law Judge. A transcript of that proceeding has been associated with the claims file. When this case was previously before the Board in March 2018 and April 2021, the above-noted issues were remanded for further development. The case has since been returned for additional appellate review. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900 (c); 38 U.S.C. § 7107 (a)(2). REASONS FOR REMAND Though untenable, the Board finds additional development is again necessary prior to final adjudication of this matter. As previously noted in the April 2021 remand, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board also previously explained that in order to be considered adequate, a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Following the most recent remand, the Veteran underwent VA neck and peripheral nerves examinations in July 2021 to assess his claimed disabilities. Following those examinations, he was again diagnosed with degenerative arthritis with intervertebral disc syndrome of the cervical spine, as well as stenosis. The Veteran was also diagnosed with bilateral upper extremity radiculopathy and carpal tunnel syndrome, as well as a right upper extremity ulnar neuropathy. The examiner then concluded the above-noted disabilities were neither incurred in service, caused by his service-connected lumbar spine disability, or aggravated by his service-connected lumbar spine disability. However, in support of these conclusions the examiner both provided medical conclusions without even slight explanations, simply indicating the medical literature did not support a causal relationship without citing to even a single medical treatise or article which supported her position. Further, the examiner also wholly failed to acknowledge or discuss the opinion previously provided by the Veteran's treating physician, which asserted the Veteran's "back and neck issues are most likely related." Based on the foregoing, the Board finds new VA examinations and medical opinions must be obtained from an Orthopedic Specialist prior to final adjudication of these matters. Accordingly, this case is REMANDED for the following actions: Afford the Veteran a VA examination by an Orthopedic Specialist Physician with sufficient expertise, who has not previously examined this Veteran, to address the etiology of the Veteran's claimed cervical spine and bilateral upper extremity neurological disabilities. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether any diagnosed cervical spine or bilateral upper extremity neurological disability at least as likely as not (a 50 percent probability or greater): a) originated during his period of active service or is otherwise etiologically related to his active service; b) was caused by his service-connected lumbar spine disability; or c) was worsened to any degree by his service-connected lumbar spine disability. The examiner must specifically address the Veteran's reports relative to the etiology of the claimed disabilities, and should also consider and expressly discuss the March 2015 note from the Veteran's treating clinician at the Houston VAMC, wherein the clinician found the Veteran's "back and neck issues are most likely related." If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.