Citation Nr: 21067347 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 18-00 368A DATE: November 4, 2021 REMANDED Entitlement to service connection for a lumbar spine disorder is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the U.S. Army from October 1964 to July 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in April 2020 and April 2021. Unfortunately, remand is again required. 1. Entitlement to service connection for a lumbar spine disorder is remanded. This issue is again remanded to obtain an adequate medical opinion regarding the etiology of the claimed lumbar spine condition. Where VA provides the veteran with an opinion in a service connection claim, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board remanded the matter in April 2021 to obtain an adequate medical opinion on the etiology of the claimed low back condition. The Board found the April 2014 examiner's opinion that a back condition was not related to service to be inadequate because the examiner did not adequately consider the Veteran's lay contentions regarding the onset of his back pain and impermissibly based the negative nexus opinion on a lack of contemporaneous service treatment records for chronic back pain. The Veteran underwent another VA examination in May 2021. The examiner diagnosed residuals status post a lumbar fusion. That examiner opined that the claimed condition was not due to the Veteran's period of service. In the rationale section, the examiner only reiterated the objective medical evidence without discussion of the relevance of that evidence to the conclusion offered. Essentially, no rationale was actually provided, thus rendering the opinion inadequate. Also, the 2021 examiner only reported a diagnosis of residuals status post lumbar fusion and did not indicate a diagnosis of degenerative arthritis or disc disease. A March 2014 VA MRI showed changes consistent with a laminectomy and fusion with residual L3-4 bulging and herniation, L4-5 and L5-S1 disk-osteophyte complexes, facet hypertrophy with resulting foraminal stenosis, L2-3 disk bulging, annular tears, spondylitic changes, and stenosis. On remand, the examiner should clarify all currently diagnosed lumbar spine conditions, and provide an opinion for each identified diagnosis. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the claimed back disorder from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) Specify all lumbar spine diagnoses present at any time since April 2013. (b.) For each diagnosed lumbar spine condition, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the lumbar spine disorder had onset in, or is otherwise related to, active service. The opinion must be supported by a thorough rationale. (c.) For any diagnosed arthritis of the lumbar spine, is it at least as likely as not that it (1) began during active service, (2) manifested within 1 year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? The opinion must be supported by a thorough rationale. (Continued on the next page) In providing the rationales, the examiner must address the lay testimony of recurrent back pain and spasms in service in addition to the 2 documented instances of lumbar spine pain despite the lack of contemporaneous medical evidence. Is there any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability? LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Smith, 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.