Citation Nr: 21072377 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 20-16 594 DATE: December 3, 2021 REMANDED Entitlement to service connection for a low back disability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1960 to August 1964. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a February 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). After reviewing all records, the Board finds there has been substantial compliance with the Board remand instructions, as an adequate medical nexus opinion (secondary service connection), along with treatment records, have been obtained. Stegall v. West, 11 Vet. App. 268 (1998). Nevertheless, the Board regrettably finds another remand is required for the following reasons. The Veteran contends that he injured his back while in service around 1961, for which he was hospitalized in service and was placed on light duty for about 6 months. He claims that he now has symptoms of muscle spasm, limited range of motion, and pain. There are two VA medical nexus opinions addressing direct service connection (December 2020 and January 2018 VA nexus opinions, in which the examiners furnished negative nexus opinions, despite acknowledging treatment for back condition in service, by emphasizing there being no chronicity of careie. no evidence of treatment or complaint of any back problems until 2017, almost 50 years after separating from service). However, it appears that there are treatment records from period earlier than 2017 showing complaints and treatments received for his back condition post-separation. Moreover, the Board points out that an October 1962 Board of Medical Summary suggests a plausible relationship between his in-service duties/activities and his then symptoms: "symptoms [of back ache/recurrent strains] began in early 1961 after the Veteran had been transferred to the ceremonial guard company. This type of duty requires frequent marching and standing pain in the low back after standing at attention for long periods of time. X-rays done in June 1961 were normal. He was found fit for admission. He did flexion exercises, but continued to notice low back pain. In November 1961, he was transferred to another platoon not requiring frequent standing and marching, back ache improved at the time. However, on January 15, 1962, he was practicing Judo when he had severe strain of the right posterior side of the thorax. He was admitted to hospital and was diagnosed with acute strain and was treated with bed rest and muscle relaxants. After being discharged, he still had some pain in the right side, but his duties were not such that he was incapacitated. All pain finally disappeared after approximately 2 months. At the time he was then returned to ceremonial guard functions. Again, he had onset of low back pain which was described as a dull aching pain that would occasionally shoot up the back. He continued to do William's flexion exercises intermittently. He stated he finally began to have a continuous ache both day and night with little relief. His symptoms were aggravated by prolonged standing and marching. He had an acute exacerbation in July 1962 when he was on field maneuvers. He was carrying a heavy log up an embankment when he felt a severe strain in the right side of his back at the site of the previous injury. He was again seen in our outpatient department on August 7, 1962 eight days after this injury. At the time, there was no evidence of spasm/any abnormality. Full duty and activities were recommended. He was placed on light duty, but symptoms on back ache continued. On August 20, 1962, was arranged for readmission, and he complained of dull aching, continuous nonreferred pain in the lumbar area and under the lower ribs. Physical examination on admission showed an increase in the normal lumbar lordotic curve, but there was no paravertebral muscle spasm and there was a full range of motion of the back. X-ray of the lumbar spine was normal. He was first placed on bed rest with limited activity...." This report also includes that "because of the increased lordotic curve the mechanical stress from prolonged standing at attention could contribute to the patient's chronic low back ache." As referred in the October 1962 Board of Medical Summary, January 1962 service treatment records document admission to hospital for lumbo-sacral sprain after falling on the right side from a Judo throw, with an impression of acute paralumbar muscle strain. An x-ray of the lumbar spine taken at the time showed no bone or joint deformity, and a physical examination showed minimal muscle spasm in the area with moderate pain/tenderness in back. The November 1962 service treatment records also show complaint of constant dull throbbing ache in lower back. Subsequent to the issuance of both VA medical nexus opinions, the Veteran also submitted a private medical nexus opinion, which provides, "spondylosis and foraminal stenosis are degenerative diseases which are often the result of participation in activities that involve repeated stress on the lower back [...] Without discontinuation of activity, the spinal column wears and becomes vulnerable to a multitude of injuries and herniations. It is at least as likely as not his life as a marine continued to aggravate his back condition precipitating a chain of events to include eventual foraminal stenosis and spondylosis." However, this opinion failed to address a long time lapse between the Veteran's separation from service and his first post-service treatment/complaints concerning back conditions addressed in the VA medical opinions. Considering that there are in-service records indicating a relationship between the Veteran's military service and his back trouble then, and a private medical opinion stating that it is at least as likely as not that his service may have aggravated a back condition which could be related to his current back condition, the Board finds a medical addendum opinion is required for addressing whether it is at least as likely as not that the Veteran's current back condition was caused by his military service, to include his in-service injuries and duties/activities in service. The matter is REMANDED for the following action: Obtain a medical addendum opinion from the December 2020 VA examiner, but if not available, from another VA examiner. The examiner must review the complete claims file, including this Remand, and then address: Whether the Veteran's current low back disability was at least as likely as not incurred in or caused by in-service injury, event, or illness, to include his in-service back injuries, treatments, and activities/duties in service (ie. working in the ceremonial guard company, which was noted to require frequent marching and standing pain in the low back after standing at attention for long periods of time). In doing so, the examiner should also expressly consider and address (1) September 2020 private medical nexus opinion, (2) October 1962 Board of Medical Summary (specifically, the role of the Veteran's duties while serving in the ceremonial guard company, having contributed to his chronic back problems then) (3) January 1962 service treatment records (documenting in-service back injury), and (4) November 1962 service treatment records. Moreover, while the December 2020 VA examiner indicated that there is no evidence of treatment or complaint of any back problems until 2017, it appears there are treatment records from an earlier time period containing complaints and treatment relating to his back condition. The examiner must provide a full supporting rationale and note his or her review of the complete claim file, including this remand. If any requested opinion is not possible without resort to mere speculation, then the examiner must explain why. If the examiner cannot provide an opinion without another VA examination, then RO must schedule one. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lee, Catherine 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.