Citation Nr: 21064899 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-48 641 DATE: October 21, 2021 REMANDED Service connection for a back condition. REASONS FOR REMAND The Veteran served on active duty from February 1985 to February 1990 and from January 1997 to June 2001. The case is on appeal from an August 2015 rating decision. In a May 2019 decision, the Board granted service connection for tinnitus; denied service connection for hyperlipidemia, hypertension, a left shoulder disability, a neck disability, and a foot disability; and remanded the claim of service connection for a back disability for additional development. Service connection for a back disability. The Veteran is seeking service connection for a back disability. He contends he has a back disability that is related to or had its onset during service due to physical training requirements and carrying heavy gear. See April 2016 Statement in Support of Claim; see also July 2015 VA examination report. Alternatively, the Veteran also asserts that his back condition is secondary to his service-connected bilateral knee condition. See October 2019 Statement in Support of Claim. In October 2019, the Veteran provided a lay statement in which he asserted his back condition is secondary to his service-connected bilateral knee condition. He stated that due to the pain caused by his service-connected knee condition, he walks with a limp that causes back pain. The Veteran also provided a private medical opinion, based on a review of the Veteran's file, authored by a nurse practitioner. The nurse practitioner noted a diagnosis of "progressive spondylitic and degenerative changes" as indicated in an April 2019 notation in the Veteran's VA treatment records. She opined that it is at least as likely as not that the Veteran's diagnosis of progressive spondylitic and degenerative changes is secondary to, related to, and/or aggravated by his service-connected bilateral knee condition. She explained that this was due to "compensatory walking strategies with biomechanical and kinematic changes." An additional VA opinion was obtained in November 2019 pursuant to the Board's May 2019 remand. The November 2019 opinion considered notations related to the Veteran's back found in his service treatment records from his first period of service that were not addressed in an earlier July 2015 VA opinion. The examiner provided a negative opinion concerning direct service connection due to an absence of complaints of back pain until the July 2015 VA examination and an absence of treatment until 2017. The examiner specifically noted physical examinations the Veteran underwent during service in December 1996, April 1998, January 1999, and June 2001 in which he failed to indicate that he was experiencing back problems. The opinion did not address the Veteran's contentions with regard to secondary service connection. In this case, the Board finds the opinions of record are not entirely adequate to decide the claim. Regarding the Veteran's assertion that his back pain is secondary to his service-connected bilateral knee condition, the October 2019 private opinion relies on the Veteran having an altered gait. Thus, it does not address how this conclusion was made in light of the fact that a normal gait is noted throughout the Veteran's VA treatment records and VA examinations. Thus, a new examination and opinion are warranted on remand. In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain VA treatment records since March 2021. 2. Schedule the Veteran for a VA examination (or telehealth interview, record review, etc., if an in-person examination is not feasible) by a qualified medical professional for an opinion to determine the nature and etiology of the Veteran's back condition. The entire claims file should be reviewed by the examiner. The examiner should diagnose any current back condition and should then answer the following questions. Is it at least as likely as not (50 percent or greater) that a current back condition was caused by the Veteran's service-connected right and left knee disabilities? Is it at least as likely as not (50 percent or greater) that a current right shoulder condition was aggravated (made worse) by the Veteran's service connected right and left knee disabilities? The examiner should address the Veteran's contention that his back condition is caused by an altered gait and the October 2019 private opinion which states that it is at least as likely than not that that the Veteran's back condition is due to an altered gait, in light of the fact that the Veteran is noted to have a normal gait throughout his VA treatment records and VA examinations. "Aggravation" is an increase in severity beyond the natural progress of the disease. A detailed rationale supporting the examiner's opinion must be provided. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Gray, 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.