Citation Nr: 21068792 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 14-01 612 DATE: November 12, 2021 REMANDED Service connection for a low back disorder is remanded. Special monthly compensation (SMC) based on the need for aid and attendance is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1986 to June 1993. After the Board of Veterans' Appeals (Board) denied service connection for a low back disorder and SMC, she appealed to the Court of Appeals for Veterans Claims (Court). In March 2021, the Court granted a Joint Motion for Partial Remand (JMPR). The Board then remanded the claims to the agency of original jurisdiction (AOJ) for additional development consistent with the JMPR in July 2021. 1. Service connection for a low back disorder is remanded. Another remand is necessary to ensure substantial compliance with the Board's prior instructions and the terms of the JMPR. Stegall v. West, 11 Vet. App. 268, 271 (1998). The parties to the JMPR agreed that remand was necessary because the 2019 VA examiner failed to provide an opinion on whether the Veteran's low back disorder was aggravated by her service-connected anemia. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (VA medical opinions on secondary service connection must sufficiently address both proximate causation and aggravation). The Board remanded to the AOJ for a new examination and medical opinion. The Veteran received a new examination in August 2021. Ultimately, the 2021 examiner determined that the low back disorder was not proximately due to or aggravated beyond its natural clinical course by the service-connected disability. However, the 2021 opinion is inadequate because the examiner did not clearly differentiate the concepts of proximate causation and aggravation. The 2021 examiner explained in the "aggravation" portion of the opinion that degenerative disc disease of the lumbar spine "is caused by aging progression" and "medical literature is insufficient for episodic iron deficiency anemia causing lumbar spine disc disease." In substance, the 2021 opinion (like the 2019 opinion) speaks to causation, not aggravation. Furthermore, the 2021 examiner did not clearly consider and discuss the Veteran's lay statements regarding the onset and course of her subjective symptoms. Miller v. Wilkie, 32 Vet. App. 249, 25960 (2020) (holding that a VA examiner "must address the veteran's lay statements to provide the Board with an adequate medical opinion"). Remand for an addendum medical opinion is therefore warranted. 2. SMC based on the need for aid and attendance is remanded. In the prior remand, the Board determined that the Veteran's SMC claim is intertwined with service connection for a low back disorder. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). Because the Board is again remanding the low back claim, the SMC claim is remanded as well. The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion on the etiology of the Veteran's low back disorder. After reviewing the claims file (including this remand), the examiner must address the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's low back disorder was incurred in or caused by service? (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's low back disorder is proximately due to her service-connected anemia? (c.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's low back disorder is aggravated beyond its natural clinical course by her service-connected anemia? The examiner must clearly consider and discuss the Veteran's lay statements regarding the onset and course of her subjective symptoms in the opinion. 2. Review the medical opinion above to ensure substantial compliance with the Board's directives. Take any necessary corrective action. 3. Readjudicate the Veteran's claims. If any claim remains denied, issue a supplemental statement of the case and allow the Veteran and her representative the opportunity to respond. Then return to the Board for further appellate review. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.Z. Wall, 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.