Citation Nr: 21069896 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 15-32 316 DATE: November 22, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1973 to July 1977. This matter comes before the Board of Veterans' Appeals ("Board") on appeal from a March 2015 rating decision of the Department of Veterans Affairs ("VA") Regional Office ("RO"). In July 2021, the Veteran testified at a Board's hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Previously, the Board remanded the matter in March 2019 to obtain a medical opinion on the nature and etiology of a cervical spine disability. Hence, the Veteran was scheduled for an examination and a medical opinion was obtained in January 2020. However, the Board finds the opinion inadequate for deciding the issue on appeal. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Regrettably, the Board finds that further remand is necessary in this matter. Entitlement to service connection for a cervical spine disability is remanded. The Veteran asserts that his cervical spine disability is directly related to his in-service injury and/or secondary to the service-connected left shoulder disability. At the July 2021 Board's hearing, the Veteran testified that he suffered injuries in a motorcycle accident in 1974 while serving in Italy and had two surgeries for the left arm and shoulder fractures. The Veteran's representative argued that the injury at a young age does not cause immediate arthritis, it takes decades before the arthritis develops. The representative also referred to an article that was cited in a March 2021 Appellate Brief, noting that shoulder pathology may cause neck pain. The representative also argued that the VA examiners' focus was on secondary service connection and they did not look at all the possibilities for service connection. In the October 2021 Appellate Brief, the Veteran's representative argued that the VA examiners did not discuss the possibility that the service-connected chronic lumbar strain, spinal stenosis, and degenerative disc disease are major factors in the Veteran's neck condition. The Board notes that the Veteran underwent a VA examination in March 2015, during which the examiner noted the diagnosis of degenerative disc disease of the cervical spine and opined that the Veteran's cervical spine disability was less likely than not (less than 50 percent probability) proximately due to or a result of his service-connected left arm condition or right shoulder condition. The examiner believed the condition was more likely than not due to age-related changes. Since the examiner did not provide opinion whether the Veterans service-connected left arm and/or right shoulder condition aggravated the cervical spine disability, the Board remanded the matter in March 2019 to obtain a new VA medical opinion on the nature and etiology of the Veteran's cervical spine disability. The Board directed the examiner to discuss the facts of the case and medical principles involved. Consequently, the Veteran was afforded another VA examination for neck condition in January 2020 and a medical opinion was obtained, in which the examiner opined that the Veteran's cervical spine disability is not caused by or aggravated by his service and/or the service-connected degenerative arthritis of the right shoulder. The examiner opined that the Veteran's cervical spine disability is due to the risk factors of aging, obesity, and gender. As a rationale, the examiner cited a medical article discussing different factors causing neck and back pain. The Board finds the January 2020 VA medical opinion inadequate because the examiner did not discuss the facts of the case, specifically the in-service motorcycle accident and its potential relationship with the Veteran's cervical spine disability, including any delayed onset of degenerative arthritis after the accident. Also, the examiner did not provide opinion whether the Veteran's cervical spine disability is secondary to the service-connected chronic lumbar strain, spinal stenosis, and degenerative disc disease. Hence, the Board finds that a remand is warranted to obtain a new VA medical opinion on the nature and etiology of the Veteran's cervical spine disability. The matter is REMANDED for the following action: 1. Obtain a medical opinion on the nature and etiology of the Veteran's cervical spine disability. In-person examination of the Veteran is left to the discretion of the clinician providing the medical opinion. If the clinician deems such examination is necessary, then an examination should be scheduled. After reviewing the claims file and copy of this remand, the examiner should address the following: (a) Provide an opinion as to whether it is at least as likely as not that the Veteran's diagnosed cervical spine disability had its onset during his period of active service, or related to an in-service injury, event, or disease, to include the 1974 in-service motorcycle accident in which he suffered many fractures in left arm, shoulder, and ribs. The examiner is advised to address if there is a possibility of a delayed onset of cervical spine arthritis due to the in-service accident. (b) Provide an opinion as to whether the Veteran's cervical spine disability is at least as likely as not (i) proximately due to or (ii) aggravated beyond its natural progression by the service-connected disabilities, including lumbar spine condition, bilateral shoulder condition, and left arm condition; and compensating one side after the left arm in-service injury. In providing the above opinions, the examiner should address the medical and lay evidence associated with the claims file with entries dated (i) 03/18/2014, titled "STR-Medical," which contains the February 1976 in-service surgery and treatment record of the Veteran's left arm; (ii) 04/11/2017, titled, "Medical Treatment Record Government Facility," page number 6 of 58 that contains an April 2003 treatment record noting the Veteran's upper back pain; (iii) 08/22/2008, titled, "Medical Treatment Record Government Facility," page number 2 of 9 that contains the April 2008 treatment record noting arm and neck pain; (iv) 09/09/2008, titled, "Medical Treatment Record Government Facility," page 2 of 32 that contains a September 2008 VA treatment record, noting that during the in-service accident the Veteran suffered from fractures of left arm, left clavicle, and left ribs; (v) 09/18/2014, titled, "C&P Exam," page number 8 of 23 that contains the September 2014 VA examination for back, in which the examiner noted that the Veteran has multiple orthopedic complaints, including his increasingly problematic neck, and that the back and right shoulder disabilities cannot be separated; (vi) 05/13/2014, titled, "Email Correspondence," in which the examiner who interpreted the Neck MRI stated, "There are degenerative changes in cervical spine particularly the C5-C6 area. This is where the nerves that go to shoulders originates. I cannot say 100% that this is the cause of problems, but the MRI is not "normal;" (vii) 03/29/2021, titled, "Appellate Brief (VSO IHP; Post remand Brief; Attorney Brief)," in which the Veteran's representative referred to an article suggesting that shoulder pathology may cause neck pain; (viii) 07/16/2021, titled, "Hearing Transcript," containing the Veteran's contentions that his neck pain directly related to his in-service accident, which might have caused a delayed onset of arthritis. (Continued on the next page) A complete rationale for the opinions rendered must be provided. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 2. Thereafter, readjudicate the claims on appeal. If the benefit sought remains denied issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Tariq, Nadeem, 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.