Citation Nr: 21067942 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 15-19 200 DATE: November 8, 2021 REMANDED The claim for service connection for a low back disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from January 1966 until his honorable discharge in December 1969. This appeal has been advanced on the Board of Veterans' Appeals' (Board) docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). This case comes before the Board of Veterans' Appeals (Board) on appeal from a September 2014 decision by the Muskogee, Oklahoma, Regional Office of the United States Department of Veterans Affairs (VA). In December 2018, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. The Board has remanded this case on three separate occasions, in December 2018, November 2020, and May 2021, in order to obtain an adequate VA medical examination and opinion addressing the etiology of the Veteran's low back disability. The adequacy of the most recent VA medical opinion dated June 22, 2021, has been challenged by the Veteran. In an April 2021 and October 2021 Informal Hearing Presentation Brief, he asserted that the VA-contracted examiner who provided a December 2020 opinion, and the subsequent June 2021 addendum opinion, was not appropriately qualified to render the opinions because he indicated that his primary area of specialty was obstetrics and gynecology. After thorough consideration of the Veteran's assertion, the Board finds it is in the interest of justice to remand the matter to the VA Regional Office to obtain a new VA opinion from an appropriately qualified clinician other than the December 2020/June 2021 examiner. Accordingly, the matter is REMANDED for the following actions: 1. Obtain any of the Veteran's outstanding VA medical records and associate them with the claims file. 2. After any additional records are associated with the claims file, obtain an addendum opinion from an appropriately qualified clinician other than the December 2020/June 2021 examiner (as his area of specialty was in obstetrics and gynecology) to provide an opinion addressing the onset and etiology of the Veteran's low back disability. The entire claims file must be made available to and be reviewed by the examiner, including a copy of this REMAND order. If the examiner decides an examination is necessary, then one shall be provided. The examiner is asked to provide an opinion addressing the following: (a.) For each of the Veteran's identified back disabilities, to include lumbar pain and lumbar spine degenerative joint disease, whether it is at least as likely as not (50 percent probability or more) that such disabilities had their onset in or are otherwise etiologically related to an in-service event, injury, or disease. In rending his or her opinion, the examiner must specifically address and discuss the following evidence, in addition to any other relevant evidence: (a.) An October 1969 service treatment record which indicates that the Veteran woke up, feeling thirsty, started to climb a ladder, and when he got to the top, he got dizzy and passed out. (b.) The Veteran's December 2018 Board hearing testimony about the incident in which he passed out while he was onboard a naval ship during his active service, and his testimony that he fell from a ladder while climbing from the fourth deck to the second deck. (c.) The Veteran's testimony that he has had leg problems since service, including numbness, cramps, and tingling. (d.) The December 2018 Board hearing testimony from the Veteran's spouse, L.P., about the Veteran's continued back problems. (e.) The February 2020 private medical opinion from a physician addressing the Veteran's back disability. With respect to this opinion, the examiner must identify and discuss all discrepancies with any findings from the private medical opinion, if any. The examiner is reminded to consider the Veteran's lay statements regarding the nature and onset of his back disability, including any evidence concerning continuity of symptomatology, as he is legally permitted to report his symptoms, past medical history, and experiences. The examiner must not opine on the credibility of the Veteran. The examiner may, however, discuss whether there is any medical reason to accept or reject the Veteran's assertion of a back disability in service or the assertion that an in-service event, injury, or illness led to his current back disability. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). A clear and detailed rationale for the opinion(s), including a discussion of the facts and medical principles involved, should be provided as it will be of considerable assistance to the Board. Please do not simply list the facts on which you relied. The examiner is informed that reliance on a lack of treatment and/or gap between discharge from military service and diagnosis of a disability, without explaining why such evidence is significant, is an insufficient rationale. The examiner is informed that the absence of contemporaneous service treatment records or medical records in general, standing alone, without explaining why such evidence is significant, is an insufficient rationale. If the examiner relies on medical treatises, the examiner should identify the treatises. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. F. Sawka, 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.