Citation Nr: 21072392 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 18-47 564 DATE: December 3, 2021 REMANDED Entitlement to service connection for cervical spine strain with spondylosis, to include as secondary to the service-connected disability of left total hip arthroplasty is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1984 to May 1988. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Augusta, Maine. In February 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding has been associated with the record. This matter was previously before the Board in March 2020 when it was remanded for additional evidentiary development. In accordance with the remand directives, relevant VA and private treatment records as well as a new VA examination were obtained. The issue is now back before the Board. Entitlement to service connection for cervical spine strain with spondylosis, to include as secondary to the service-connected disability of left total hip arthroplasty is remanded. While additional delay is regrettable, further development is required to fairly decide the Veteran's claim. In accordance with the March 2020 Board remand, the Veteran was afforded a VA examination in August 2020, but the claim must be remanded again because there has not been substantial compliance with the remand directives; specifically, the August 2020 VA examination is inadequate. Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran contends that his neck problems started in 2015 after he underwent left hip replacement surgery. See February 2020 Hearing Transcript. The Veteran is currently service-connected for left total hip arthroplasty. In accordance with the March 2020 Board remand, the Veteran was afforded a VA examination in August 2020. The VA examiner noted diagnoses of degenerative arthritis of the spine and cervical spine strain with spondylosis. The Veteran reported a symptom onset in 2014, noted as neck pain radiating to the middle of his back and limited range of motion. Following a physical examination and review of the evidence, the VA examiner opined that the Veteran's cervical spine strain with spondylosis is less likely than not proximately due to or the result of his service-connected left total hip arthroplasty. In support of this opinion, the VA examiner reasoned that arthritis in one joint does not cause arthritis in another joint. The Board notes that the Veteran is specifically contending that his cervical spine strain and/or pinched nerve, not arthritis, is due to his service-connected left hip disability. See October 2020 Representative Statement. Furthermore, in the March 2020 remand directives, the Board specifically directed the VA examiner to opine on direct and secondary service connection for the Veteran's cervical strain with spondylosis. The VA examiner's reasoning only discussed the Veteran's arthritis. Thus, as the VA examiner incorrectly opined as to the Veteran's arthritis instead of his cervical spine strain, the Board finds the August 2020 opinion inadequate and remand is warranted for an addendum opinion. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a qualified examiner to determine the etiology of his cervical spine strain with spondylosis, also identified as a "pinched nerve." The examiner should review the Veteran's claims file, including a copy of this Remand, the February 2020 hearing transcript and after considering the Veteran's lay statements, comment on the following questions: (a.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that the Veteran's cervical spine strain with spondylosis was caused by or incurred during his military service? (b.) Is it at least as likely as not (i.e., probability of 50 percent or higher) that the Veteran's cervical spine strain with spondylosis is proximately due to or the result of the Veteran's service-connected left hip arthroplasty? (c.) If the answer to (a)& (b)is negative, is it at least as likely as not that the cervical spine strain with spondylosis is aggravated (i.e., permanently or temporarily worsened) by the service-connected left hip arthroplasty? If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner's opinion, are proximately due to the service-connected left hip arthroplasty. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). 2. After completing all actions set forth above and any further action needed because of the above development, readjudicate the service connection claim on appeal. If any benefit on appeal remains denied, the RO should furnish to the Veteran and his representative an appropriate Supplemental Statement of the Case (SSOC) and allow the appropriate time for response. Then return the case to the Board for further appellate review. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. C. Slaughter, 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.