Citation Nr: 21073836 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 19-38 719 DATE: December 10, 2021 REMANDED Entitlement to service connection for a low back disorder, characterized as degenerative arthritis, to include as secondary to residuals of a right foot disability, is remanded. Entitlement to service connection for a right hip disorder, characterized as hip strain, to include as secondary to residuals of a right foot disability, is remanded. Entitlement to service connection for a left hip disorder, characterized as hip strain, to include as secondary to residuals of a right foot disability, is remanded. Entitlement to service connection for right lower extremity sciatic radiculopathy, to include as secondary to a low back disorder, is remanded. Entitlement to service connection for left lower extremity sciatic radiculopathy, to include as secondary to a low back disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1964 to September 1966. In September 2021, the Veteran testified at a Board of Veterans' Appeals (Board) hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for a low back disorder, characterized as degenerative arthritis, to include as secondary to residuals of a right foot disability, is remanded. 2. Entitlement to service connection for a right hip disorder, characterized as hip strain, to include as secondary to residuals of a right foot disability, is remanded. 3. Entitlement to service connection for a left hip disorder, characterized as hip strain, to include as secondary to residuals of a right foot disability, is remanded. 4. Entitlement to service connection for right lower extremity sciatic radiculopathy, to include as secondary to a low back disorder, is remanded. 5. Entitlement to service connection for left lower extremity sciatic radiculopathy, to include as secondary to a low back disorder, is remanded. The Veteran is seeking service connection for a low back disorder and bilateral hip disorders which he claims are secondarily caused or aggravated by a service-connected right foot residuals disability. Additionally, he is seeking service connection for bilateral lower extremity sciatic radiculopathy disorders which have been found to be related to his low back disorder. After a review of the evidence of record, the Board finds that the Veteran's claims must be remanded to correct inadequate medical opinions. The Regional Office (RO) previously denied the Veteran's claims on appeal finding no connection between them and service, including as due to, or aggravated by his right foot residuals. Moreover, the RO and previous VA examiners have concluded that the Veteran had a low back disorder prior to his active-duty service and this disorder was not aggravated beyond its natural progression by his service, including by his right foot residuals. The law provides that Veterans are presumed sound upon entry into service except for conditions noted upon entry or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto and was not aggravated by such service. Only such disorders as are recorded in examination reports are considered as noted. 38 U.S.C. § 1111; 38 C.F.R. § 3.304 (b). History of pre-service existence of disorders recorded at the time of examination does not constitute a notation of such disorders but will be considered together with all other material evidence in determinations as to inception. 38 C.F.R. § 3.304 (b)(1). When no preexisting condition is noted upon entry into service, a veteran is presumed sound. Wagner v. Principi, 370 F.3d 1089, 1096 (Fed.Cir.2004). In making the determination that the Veteran's low back disorder predated active-duty service, the RO noted that the Veteran's 1964 report of medical history noted an injury to the Veteran's back, due to a fall, six years prior. However, the notes from that report of medical history point out that symptoms of back pain and dizziness abated in a short period after the Veteran's fall, and that there were no noted subsequent issues. There are no additional records that substantiate that the Veteran had a preexisting chronic back disorder at the time of his induction in June 1964. Thus, the Board must conclude that there is no clear and unmistakable evidence which indicates that the Veteran's current low back disorder existed prior to service. Importantly, the two prior VA examination reports, dated November 2019 and February 2021, are based around the idea that the Veteran had a back disorder prior to service. The November 2019 report notes that the Veteran experienced low back symptoms in service, while the February 2021 report does not. The February 2021 examiner stated that the Veteran's bilateral hip disorder is unrelated to his right foot residuals as medical literature does not relate the two, there is no discussion of the Veteran's altered gait, or the many documented falls he has sustained due to his right foot residuals. Both reports conclude that the Veteran's low back disorder was not aggravated beyond its natural progression due to service or his right foot residuals and note that the low back disorder predated service; there is no further elaboration. Moreover, there was no discussion, in either examination report, of the submitted private medical opinions, which document the effects of his right foot residuals and their impact on his back and hips. Given the lack of both an adequate rationale and discussion of relevant evidence in the conclusions made by the November 2019 and February 2021 examiners, the Board finds that these examinations are inadequate for the purposes of adjudicating the Veteran's claims, and a remand is necessary. Finally, because a decision on the Veteran's claim for his low back disorder could significantly impact a decision on the Veteran's claims for bilateral lower extremity sciatic radiculopathy, the issues are inextricably intertwined. A remand of the claims for bilateral lower extremity sciatic radiculopathy is required. The matters are REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900 (c). Expedited handling is requested.) 1. The RO should invite the Veteran to submit any additional evidence relevant to his claims for service connection for a low back, bilateral hip, and bilateral sciatic radiculopathy disorders. 2. Schedule the Veteran for new examinations, with an appropriate clinician, to determine the nature, extent, onset, and etiology of his low back, bilateral hip, and bilateral sciatic radiculopathy disorders. The complete claims file should be made available to the examiner. The examiner should provide opinions as to whether it is at least as likely as not (a 50 percent or greater probability) that his low back, bilateral hip, and bilateral sciatic radiculopathy are etiologically related to the Veteran's period of service, or to his right foot residuals disability. When discussing whether it is as likely as not that the Veteran's claimed disorders are secondarily related to his right foot residuals, the examiner should discuss if the claimed disorders are caused and/or aggravated by his right foot residuals disability. "Aggravated" means to cause any increase in severity that is beyond the normal progression of the disability. The examiner is asked to consider and respond to the private medical opinions that have been previously submitted by the Veteran. In particular that his altered gait has led to the claimed disorders on appeal. The examiner should also consider and address the Veteran's competent lay statements regarding his right foot residuals and its effects on his low back and hips. All opinions should be accompanied by adequate reasons and bases. If the examiner cannot provide the requested opinion without resorting to mere speculation, they should provide a complete explanation stating why this is so. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Hernan, Attorney Advisor