Citation Nr: 21068663 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 17-36 839 DATE: November 12, 2021 REMANDED Service connection for a cervical spine disability is remanded. Service connection for a thoracic spine disability is remanded. Service connection for a lumbar spine disability is remanded. Service connection for a chronic sinus condition is remanded. Service connection for a left lower extremity nerve condition is remanded. Service connection for a left foot condition is remanded. A total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1990 to May 1998, with additional reserve service. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). During the pendency of the appeal in an October 2020 decision, the RO granted service connection for a sleep disorder, migraine headaches and a left knee disability. Therefore, those issues are no longer before the Board. While the Board regrets further delay, remand is necessary to ensure proper development of the claims. Specifically, the Board remanded the claims in February 2019 in part to obtain updated VA examinations and opinions for the claims that had been reopened. While these examinations and opinions were obtained, insufficient rationales were provided. Cervical, thoracic, and lumbar spine disabilities Regarding disabilities of the neck and back, September 2020 VA examinations diagnosed degenerative disc disease of the cervical and lumbar spines. The examiner noted an in-service motor vehicle accident which caused neck and back pain, however, found that it was less likely than not that the current conditions were related to the in-service incident as the Veteran experienced three other motor vehicle accidents since service. The examiner did not address the Veteran's reports that the symptoms had continued since service, nor did the examiner provide any opinion regarding whether the in-service accident triggered the conditions that subsequent accidents may have exacerbated. A January 2021 VA opinion provided no rationale at all, noting inaccurately, that there was no record of treatment or complaints related to the cervical, thoracic or lumbar spines during service. Therefore, remand is necessary to obtain adequate opinions. Chronic sinus condition The claim for a chronic sinus condition must also be remanded, as the opinion of record is inadequate. A September 2020 VA examiner diagnosed chronic sinusitis and opined that a nexus could not be established as the Veteran was not diagnosed until May 2020. However, a gap in the medical record between service and formal diagnosis is not a bar to service connection for chronic disabilities. Therefore, remand is necessary to obtain a new VA opinion. Left lower extremity nerve condition Left foot condition TDIU The Board finds that the claims for service connection for a left foot condition, left lower extremity nerve condition and TDIU must also be remanded, as they were intertwined with the other issues being remanded. Regarding the foot and left lower extremity, the Veteran claims that these are directly related to a lumbar spine disability, and the record contains a positive nexus relating the nerve conditions with the Veteran's lumbar spine disability. The matters are REMANDED for the following action: 1. Associate any pertinent VA or private medical records that are not already of record with the claims file. 2. Obtain addendum opinions from medical examiners who have not previously provided opinions regarding the nature and etiology of any cervical spine, thoracic spine, lumbar spine, left lower extremity nerve condition, left foot condition, and chronic sinus condition. The examiner must review the claims file, including previous VA examinations, and should note that review in the report. If the examiner finds that an in-person examination is required to render an opinion, please schedule a VA examination per the examiner's request. The examiner should opine as to whether it is at least as likely not (50 percent or greater probability) that any diagnosed disability had its onset in service or is otherwise related to service. Regarding the neck and back, the examiner should specifically address the Veteran's lay statements and reports that he has experienced symptoms related to the neck and back since an in-service motor vehicle accident. Complete rationales should be provided. The Board notes that a gap in the medical record is not a sufficient rationale for a lack of nexus. The examiner should also describe the symptoms and effects of all of the Veteran's service-connected disabilities on employment. If the Veteran is felt capable of work, the examiner should state what type of work and what accommodations would be necessary due to the service-connected disabilities. The examiner should set forth the complete rationale for all opinions expressed and conclusions reached. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Ahmad 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.