Citation Nr: 21065935 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 13-14 959 DATE: October 28, 2021 REMANDED Entitlement to service connection for a back disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from March 1969 to February 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal of a May 2011 Department of Veterans Affairs (VA) rating decision. In his May 2013 VA Form 9, the Veteran requested a Board hearing. In June 2013 he withdrew the hearing request. In January 2017, this matter was remanded for additional development, and the Veteran filed an appeal to the United States Court of Appeals for Veterans Claims (CAVC). In June 2017, CAVC dismissed the appeal for lack of jurisdiction. In June 2018, this matter was remanded for additional development. [The June 2018 decision granted all other issues pending on appeal.] Entitlement to service connection for a back disability. The June 2018 Board remand ordered development for obtain outstanding treatment records and an VA examination to ascertain the nature and etiology of the Veteran's current back disability. The examiner was to identify each back disability found (or shown by the record) and opine regarding each back disability diagnosed, whether it was related to the Veteran's service or was caused or aggravated by his service-connected disabilities. Specifically, the examiner was to address whether any current present back disability was caused or chronically worsened by altered gait and/or body mechanics resulting from a service-connected disability. On November 2029 VA examination, degenerative arthritis of the spine and facet joint hypertrophy were diagnosed. The examiner, a nurse practitioner, addressed secondary service connection and opined that the back disability and feet disabilities are not medically related. The back disability is a separate entity entirely and unrelated to his feet disabilities. The examiner indicated that no antalgic gait was evident on examination of the Veteran. The examiner did not address whether the Veteran's back disability is secondary to his other (right and left knee), service-connected disabilities or whether the service-connected disabilities resulted in altered body mechanics that caused or aggravated his back disability. Accordingly, another examination for a fully adequate medical opinion in this matter is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). [The Board notes that SSA records related to his back disability were associated with the record during the pendency of this claim. The SSA records suggest that the Veteran sustained a postservice back injury in October 2010 approximately thirty-nine years after his separation from service.] The matters are REMANDED for the following action: Arrange for the Veteran's claims file to be forwarded to an appropriate clinician (in orthopedics) other than the November 2019 examiner for review and a medical advisory opinion regarding the likely etiology of his back disability. [If further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] The examiner should provide opinions that respond to the following: (a.) Identify (by diagnosis) each back disability shown during the pendency of this claim. If degenerative arthritis of the spine and facet joint hypertrophy are not diagnosed, reconcile that finding with the notations in the record suggesting otherwise. (b.) Identify the likely etiology for each back disability entity diagnosed. Is it at least as likely as not (a 50% or better probability) that it was incurred during the Veteran's active service? (c.) If the response to (b) is no, is it at least as likely as not that the diagnosed disability was caused or aggravated by the Veteran's service-connected (foot and left and right knee) disabilities, to include as due to an altered gait or altered body mechanics due to a service-connected disability? [The rationale for this opinion must address aggravation and must address altered gait and altered body mechanics.] (d.) If a back disability diagnosed is found to not have been caused, but to have been aggravated, by a service-connected disability, identify the baseline severity of such disability prior to the aggravation and the level of severity of the disability following aggravation. All opinions must include rationale that cites to supporting factual data and/or medical literature, as deemed appropriate. If an opinion sought cannot be provided without resort to mere speculation, there must be explanation why that is so. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lederman, Michael 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.