Citation Nr: 21064948 Decision Date: 10/22/21 Archive Date: 10/22/21 DOCKET NO. 17-11 011 DATE: October 22, 2021 REMANDED Entitlement to service connection for an upper back condition secondary to the service-connected disability of encephalitis residuals to include disequilibrium and headaches, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1992 to October 1999. This case comes before the Board of Veterans' Appeals (Board) on appeal of a November 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) in March 2014, November 2020, and May 2021. This case was last before the Board in July 2021. The Board remanded the case for the RO to issue a Supplemental Statement of the Case (SSOC). In August 2021, the RO issued the SSOC. The case is now before the Board. The Veteran contends that her upper back condition is secondary to her service-connected disability of encephalitis residuals to include disequilibrium and headaches. The Veteran was afforded a VA examination and opinion in March 2020. The examiner noted a thoracolumbar strain and degenerative disc disease. The examiner noted that the Veteran had tried physical therapy and chiropractic treatment, but it did not help much. The examiner wrote, "[t]he Veteran opines that the back pain is related to the changes in her positioning due to her disequilibrium with resultant strain on her back. This is unlikely the cause of her thoracic/back strain and arthritis which is more likely due to the wear and tear with age." No other opinions were rendered. The Board finds that the March 2020 opinion lacks an adequate rationale as to the Veteran's service-connected encephalitis residuals to include disequilibrium and headaches causing or aggravating the Veteran's upper back disability. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). The October 2020 opinion only included language that the Veteran's disequilibrium was unlikely the cause of her back pain and that arthritis is more likely. The language used in the opinion is not the standard for secondary service connection. See Ward v. Wilkie, 31 Vet. App. 233 (2019). Additionally, the examiner failed to address the Veteran's documented altered gait and how that may have an impact on her upper back disability. Private medical records from October 2011 from the Veteran's orthopedic physician, Dr. C.C., show that the Veteran's abnormal gait pattern may be as likely as anything to be causing her current upper back problems. The Board finds the March 2020 opinion inadequate to adjudicate this appeal, and another remand is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matter is REMANDED for the following action: After completing any development deemed necessary, afford the Veteran a VA examination with an appropriate medical professional. The claims file, including all hearing transcripts, all VA examinations and opinions, and private medical records, must be made available for review by the examiner. The examiner must review the entire claims folder, and this fact must be noted in the accompanying medical report. The examiner should determine: a.) Whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the Veteran's claimed upper back condition had its onset in service or is otherwise etiologically related to active service. b.) Whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the Veteran's claimed upper back condition was caused or aggravated by the Veteran's service-connected disability of encephalitis residuals to include disequilibrium and headaches. The Board notes that causation and aggravation are independent concepts and need separate findings and rationales. Atencio v. O'Rourke, 30 Vet. App. 74 (2018). The examiner is reminded that there is NO requirement of "permanent aggravation." A rationale is necessary for all opinions. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hetman 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.