Citation Nr: 21072444 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 17-11 414 DATE: December 3, 2021 REMANDED Entitlement to service connection for degenerative arthritis of the thoracolumbar spine (claimed as back strain) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1976 to September 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. The Veteran was afforded the opportunity to submit supporting medical documentation within a 90 day window subsequent to the hearing. Evidence received within the 90 day window includes a September 2021 private opinion. The Veteran contends he is entitled to service connection for a low back disability, to include as secondary to his service connected bilateral knee disabilities. The Veteran specifically contends that due to his service-connected conditions, which occurred during a motor vehicle accident while in service, he overcompensates his gait which has caused a low back disability. See June 2016 Notice of Disagreement. The Veteran was afforded a VA examination for his back in November 2015. The examination report noted review of the service treatment records, military service personnel records, medical records, recounted the Veteran's complaints and history, and included an in-person examination. There was a diagnosis of degenerative arthritis of the spine. The examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran's service connected condition. The rationale provided was that the Veterans service treatment records did not indicate evidence of a back injury. Further, he left service in 1979 and his records do not contain a diagnosis or complaint of back pain until 2014. Since service, the Veteran worked as a heavy labor in mining and the post office. The examiner found that the Veteran's "current back pain is consistent with the natural progression of arthritis in a 61 year old male who has a long history of physical labor." The Board finds the November 2015 VA examiner provided an adequate opinion regarding secondary causation, but failed to fully address direct service connection; and the theory of secondary service connection by aggravation under 38 C.F.R. § 3.310(b). In September 2021, the Veteran submitted a private treatment letter from his chiropractor in support of his claim. The chiropractor reviewed magnetic resonance imaging (MRI) reports of the knees, a November 2015 MRI of the lumbar spine, and performed an orthopedic examination. It was opined that the Veteran's arthritic changes and ailments have a direct correlation with the injuries sustained during an in-service motor vehicle accident when the Veteran "was thrown from the military vehicle." While the private opinion links his low back disability to service, it lacks a supporting rationale. Additionally, the chiropractor did not review the Veteran's claims file, including the Veteran's service treatment records. Therefore, little probative weight is assigned to the September 2021 private opinion. Accordingly, the private opinion is insufficient upon which to grant service connection. Although the Board regrets the delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Accordingly, remand is appropriate for a supplemental VA medical opinion with adequate reasoning for its conclusions and addresses direct service connection, to include the in-service motor vehicle accident as postulated in the September 2021 private opinion; and the theory of secondary service connection by aggravation. The matters are REMANDED for the following action: 1. Associate with the claims file any outstanding VA or private medical records. Take appropriate efforts to obtain any records identified by the Veteran or otherwise. 2. Obtain a supplemental VA medical opinion, from an appropriate examiner, concerning the issue of entitlement to service connection for low back disability. If the VA examiner deems that another physical examination is necessary to provide the requested opinion, the Veteran shall be afforded an opportunity to attend such an examination. The examiner shall respond to the following question: (a.) Is it at least as likely as not (50 percent probability or greater) that any current low back disability was incurred in or as a result of active duty service? In providing this opinion, the examiner should consider and discuss the in-service motor vehicle accident and the September 2021 private opinion. (b.) Is it at least as likely as not (50 percent probability or greater) that any current low back disability was aggravated (increased in severity) beyond its natural progression by a service-connected disability, to include right knee instability, right knee arthritis, and/or left knee instability? In this regard, consider any gait changes these service-connected disabilities may have caused in relation to aggravation of the current low back disability. Note: All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After completion of the above, and any other development deemed necessary, readjudicate the claim on appeal. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.M. Edwards, 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.