Citation Nr: 21066932
Decision Date: 11/02/21	Archive Date: 11/02/21

DOCKET NO. 14-29 527
DATE: November 2, 2021

REMANDED

Service connection for a lumbar spine disorder is remanded.

Service connection for hypertension is remanded.

Entitlement to a total disability rating based on individual unemployability is remanded.

REASONS FOR REMAND

The Veteran served on active duty from January 1976 to November 1988 and from February 1989 to April 1996.  He is in receipt of a Combat Action Ribbon, in addition to several other medals and awards.

This matter comes before the Board of Veterans' Appeals (Board) from August 2013 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the issues on appeal for additional development in November 2016 and September 2020. 

1. Service connection for a lumbar spine disability is remanded.

2. Service connection for hypertension is remanded. 

In compliance with the Board's prior remand directives, the Veteran underwent VA examinations in February 2021. In August 2021, a VA examiner opined that the Veteran's currently diagnosed degenerative arthritis of the spine is not related to environmental hazards the Veteran was exposed to during service in Southwest Asia as the condition is due to degeneration of the spine joints due to repeated trauma or age-related factors. Similarly, the examiner opined that the Veteran's hypertension is less likely than not incurred in or caused by the environmental hazards he was exposed to while serving in Southwest Asia because hypertension is due to several factors like smoking, obesity, sedentary lifestyle, hypercholesterolemia, and certain systemic diseases. 

As the Veteran's lumbar spine disability and hypertension are diagnosed conditions, they cannot be considered an undiagnosed illness, but they are eligible for consideration as a medically unexplained chronic multisymptom illness (MUCMI).  38 C.F.R. § 3.317(a)(1)(ii), (a)(2)(ii). As the obtained VA opinions do not appear to address the etiology and pathophysiology of the disabilities within the context of the Veteran's specific case, additional development is necessary.

3. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.

The Veteran's July 2012 VA Form 21-8940 indicates that he believes his knees, fatigue, back, and hypertension render him unemployable. Thus, because a decision on the remanded issues of lumbar spine disability and hypertension could significantly impact a decision on the issue of TDIU, the issues are inextricably intertwined.  A remand of the claim for TDIU is required.

The matters are REMANDED for the following action:

Obtain an addendum opinion to determine the nature and etiology of the Veteran's lumbar spine disability and hypertension. The examiner is asked to provide responses to the following: 

(a.) Is the etiology of the Veteran's lumbar spine degenerative arthritis and hypertension (1) inconclusive, (2) partially understood, or (3) fully understood? 

This determination must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole.

(b.) Is the pathophysiology of the Veteran's lumbar spine degenerative arthritis and hypertension (1) inconclusive, (2) partially understood, or (3) fully understood? 

This determination must be based on the Veteran's specific case and cannot be based on the pathophysiology of the disease or disability population as a whole.

(c.) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran's lumbar spine degenerative arthritis and hypertension were incurred in, or are otherwise related to, his active service?

A complete rationale must be provided for all opinions expressed.

 

 

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M.Aoughsten, 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.