Citation Nr: 21073361 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-04 580 DATE: December 8, 2021 REMANDED Entitlement to service connection for cervical spine disability is remanded. REASONS FOR REMAND The Veteran served in the United States Army on active duty from May 1968 to May 1970. The issue comes before the Board of Veterans' Appeals (Board) on appeal from an August 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in November 2020. A transcript of the hearing has been included with the record. In January 2021, the Board remanded this claim for additional development. Entitlement to service connection for cervical spine disability is remanded. The Veteran contends that his cervical spine disability is related to active-duty service, including as secondary to his service-connected conditions. VA's duty to assist includes providing an examination and obtaining a medical opinion when such an examination or opinion is necessary to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159. VA has a duty to provide the veteran a thorough medical examination, one which takes into account the veteran's prior medical history and provides sufficient detail so that the Board's evaluation of the claimed disability is fully informed. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, when a veteran's claim includes a secondary service connection theory of entitlement, VA must provide an opinion as to whether the veteran's claimed disability is proximately due to or aggravated by his service-connected disabilities. See 38 C.F.R. § 3.310. Causation and aggravation are independent concepts, and VA must ensure medical examinations have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 299-304 (2008). Additionally, an examination must consider lay persons' competent opinions on certain subjective medical issues and of observable symptomatology and medical history. Miller v. Wilkie, 32 Vet. App. 249, 260 (2020). The Board finds remand is necessary to provide the Veteran a medical opinion adequately addressing the etiology of the Veteran's cervical spine disability as secondary to the Veteran's service-connected ankle and low back disabilities. The February 2021 VA examiner opined that the Veteran's cervical spine disability was not at least as likely as not aggravated beyond its natural progression by the Veteran's service-connected conditions. The February 2021 VA examiner provided the rationale that the Veteran's service-connected right ankle disability and lumbar spine condition did not aggravate the Veteran's cervical spine condition beyond its natural progression. The VA medical opinions are absent of reasoned medical explanation and without supporting data, needed to adjudicate the Veteran's claim. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A mere conclusory medical opinion is insufficient. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Without a medical opinion that clearly addresses the relevant facts and medical science, the Board is left to rely on its own lay opinion, which it is forbidden from doing. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, remand is required to obtain a medical opinion, with adequate rationales in support, to address the Veteran's cervical spine condition secondary to his service-connected right ankle and lumbar spine disabilities. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's cervical spine disability. The examination may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. Following a review of the entire record, the examiner should opine as to: a) Whether it is at least as likely as not (50 percent probability or more) that the Veteran's cervical spine condition was proximately due to, or the result of, his service-connected right ankle or lower back disabilities. b) Whether it is at least as likely as not (50 percent probability or more) that the Veteran's cervical spine condition was aggravated by his service-connected right ankle or lower back disabilities. If secondary service connection is not found, please provide an opinion as to: c) Whether it is at least as likely as not (50 percent probability or more) that the Veteran's cervical spine condition is related to the Veteran's active military service. For purposes of this examination and opinion, the examiner must consider the full record, to include VA and private medical treatment records, the Veteran's lay statements, and lay statements submitted by the Veteran's ex-wife and fellow service member. The examiner must provide a comprehensive report including a clearly stated rationale for any opinions offered and conclusions reached, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability. If such reports are rejected by the examiner, a reason for doing so must be provided. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.V. Bona, 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.