Citation Nr: 21068012 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 16-38 817 DATE: November 8, 2021 REMANDED Entitlement to service connection for a back condition including spinal stenosis, degenerative disc disease (DDD), and disc herniation is remanded. Entitlement to service connection for bilateral hip replacement, claimed as secondary to a back condition, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1969 to March 1976. These claims are on appeal to the Board of Veterans Appeals (Board) from a February 2015 rating decision. In October 2018 and again in June 2021, the Board remanded the Veteran's claims to obtain examinations and opinions to determine the etiology of his claimed disabilities. 1. Entitlement to service connection for a back condition including spinal stenosis, DDD, disc herniation The Veteran contends he was born with spinal stenosis but that this condition was aggravated due to his military service. See March 2016 VA Form 27-0820 and June 2015 Notice of Disagreement (NOD). The matter was previously remanded by the Board in October 2018 and June 2021. Regrettably, the Board's review of the claims file shows that the RO did not substantially comply with the June 2021 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (finding that veterans are entitled to compliance with Board remand instructions). Accordingly, the claim is remanded again for corrective action, as set forth below. In the June 2021 remand, the Board noted that the prior October 2018 remand had identified the Veteran's dates of service incorrectly, and therefore any opinions previously expressed were based on an incorrect factual premise regarding the Veteran's length of service. The decision further noted that the examiner who provided the opinions failed to use the appropriate legal standards. Specifically, the Board noted the examiner had stated spinal stenosis worsens over time, yet determined it was a congenital defect with no explanation for this finding rendered. Therefore, the Board remanded with very specific instructions. After an in-person examination was conducted, the examiner was first required to explain whether spinal stenosis was a congenital disease or a defect, with explanation for such determination and appropriate citation to accepted medical literature if possible. If the answer was that spinal stenosis is a defect, the examiner was to determine whether it was at least as likely as not that there was a superimposed injury or disease in service that resulted in additional disability. In rendering this opinion, the medical professional was asked to discuss the post-service diagnosis of degenerative changes and herniated discs. If the answer was that spinal stenosis is a disease, the examiner was instructed to determine whether there was clear and unmistakable evidence that the condition pre-existed active service. If so, the examiner was asked to opine whether the evidence showed the congenital spinal stenosis was not aggravated by service or that any increase in disability was not due to the natural progression of the disease. After this spinal stenosis evaluation, the examiner was further asked to separately determine with regards to both the diagnoses of degenerative changes of the thoracolumbar spine and herniated discs whether it was at least as likely as not that these disabilities began during service, were manifested within one year of service, or were otherwise etiologically related to the Veteran's active service. Pursuant to the Board's remand, the Veteran was provided VA examinations in July 2021. The Board notes that these examinations did comply with the spinal stenosis instructions in finding that, in this particular instance, the Veteran's spinal stenosis was at least as likely as not congenital based upon an MRI done in 1991 and that it was less likely than not there was any superimposed injury or disease in service that resulted in additional disability. The examiner further did opine that it was less likely than not that the Veteran's degenerative changes were either incurred in service or manifested one year from separation. However, it does not appear a similar opinion was rendered regarding the diagnosis of herniated disks pursuant to part (f) of the remand directives. Accordingly, the Board finds that an addendum VA medical opinion is necessary to fully comply with the Board's remand directives. Stegall, 11 Vet. App. at 271. 2. Entitlement to service connection for bilateral hip replacements as secondary to a back condition The Veteran's March 2016 Report of General Information explains his contention that his hip replacements are secondary to his back condition. Therefore, the Veteran's claims for these disorders are inextricably intertwined with the claim for service connection for spinal stenosis and other back conditions remanded herein. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Remand of the inextricably intertwined claims is, thus, also required. The matters are REMANDED for the following action: Following a review of the record and with consideration of the Veteran's statements, the medical professional must opine as to the following: (a) With respect to the diagnosis of herniated disks, determine whether it is at least as likely as not (50 percent probability) that this disability (i) began during service, or (ii) is otherwise etiologically related to the Veteran's active-duty service. If the examiner determines that a physical examination is necessary to provide any of the requested opinions, such should be scheduled. A rationale for all opinions expressed should be provided to the greatest extent possible. If the examiner finds it impossible to render any requested opinion without resorting to speculation, they should explain why that is the case. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Stuedemann, Angela L. 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.