Citation Nr: 21064192
Decision Date: 10/19/21	Archive Date: 10/19/21

DOCKET NO. 11-18 528A
DATE: October 19, 2021

REMANDED

Entitlement to service connection for a low back disability is remanded.

REASONS FOR REMAND

The Veteran had active service from January 1963 to January 1966 and from November 1967 to November 1971.

The Board remanded this issue in October 2015, March 2017, November 2017, and August 2020.

The Veteran seeks entitlement to service connection for a low back disability, which he contends is secondary to his service-connected prostate cancer.  Specifically, he contends that the prostate cancer caused or aggravated his low back disability, as he first experienced low back pain shortly after he underwent a radioactive seed implantation procedure to treat his prostate cancer.

In the August 2020 remand, the Board directed the agency of original jurisdiction to obtain an opinion as to whether the Veteran's current low back disability may be caused or aggravated by his service-connected disabilities, to include his prostate cancer and the radioactive seed implantation procedure he underwent to treat that condition.  The Board specified that the clinician should discuss the medical significance, if any, of the Veteran's assertions that his current low back pain began shortly after his seed implantation surgery.

Pursuant to the August 2020 remand, the Veteran was afforded a VA back conditions examination in February 2021.  The February 2021 VA examiner found that the Veteran's low back disability is less likely than not proximately due to or aggravated by his service-connected prostate cancer.  However, the rationale for that opinion does not reflect consideration of the Veteran's assertions that his current low back pain began shortly after his radioactive seed implantation surgery.  Rather, in regard to secondary causation, the examiner merely provided a medical definition of degenerative arthritis and a list of complications of prostate brachytherapy.  In regard to secondary aggravation, the examiner provided only a conclusory statement that "There is no objective findings or medical literature to support veteran's degenerative disc disease ... was aggravated beyond its natural progression by service connected Prostate Cancer."  Therefore, the opinion is not adequate for decision-making purposes, and the issue must be remanded for a further opinion.

The Board notes that in July 2021, the Veteran submitted literature from the Mayo Clinic concerning back pain.  That literature states, "Some types of arthritis and cancer can contribute to back pain", and "People prone to depression and anxiety appear to have a greater risk of back pain."  The opinion obtained on remand should address that medical literature, to include the possibility it raises that the Veteran's low back disability and the pain it causes may be secondary to his service-connected posttraumatic stress disorder.

The matters are REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's low back disability is at least as likely as not (50 percent probability or greater) proximately due to or aggravated beyond its natural progression by a service-connected disability, to include his prostate cancer, the radioactive seed implantation procedure he underwent to treat his prostate cancer, and his posttraumatic stress disorder.

The clinician must discuss the medical significance, if any, of the Veteran's assertions that his current low back pain began shortly after his seed implantation procedure and the medical treatment records that appear to show that the Veteran began reporting low back pain around the same time he underwent treatment for prostate cancer.  The clinician must also discuss the literature from the Mayo Clinic that the Veteran submitted in July 2021, which states, "Some types of arthritis and cancer can contribute to back pain", and "People prone to depression and anxiety appear to have a greater risk of back pain."

 

 

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. J. Anthony, 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.