Citation Nr: 21074074 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 16-54 306 DATE: December 14, 2021 REMANDED Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected bilateral plantar fasciitis and/or service-connected right and left hallux valgus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from March 1980 to April 1992 and from March 2003 to March 2004. The Veteran had additional service in the reserves. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2016 rating decision. The Board remanded the issue in December 2018, January 2020, and July 2021 for further development. The July 2021 Board remand requested an addendum medical opinion to determine the nature and etiology of the Veteran's back disabilities. Unfortunately, remand is again required, as the medical opinions obtained in response to the July 2021 remand are inadequate. Specifically, VA opinions were provided in September 2021. The VA examiner opined that it was less likely than not that the Veteran's back disability was incurred in or caused by an in-service injury, event, or illness because there was no evidence in the Veteran's service treatment records documenting military duties that would likely cause chronic lower back pain. However, the examiner failed to consider the Veteran's contentions that: carrying heavy combat loads of 70 pounds or more over rough terrain during repeated conditioning hikes, tactical movement, exercises, and deployments affected his back; and ill-fitting service footwear and standing in formations on hard surfaces and close order drill over a period of years impacted his back. Accordingly, the direct service connection opinion is inadequate. Regarding the secondary service connection opinion, the Board finds that the VA examiner's rationale was insufficient to support the negative secondary service connection opinion. In fact, no substantive rationale was provided beyond a generic reference to unidentified medical literature. The Board emphasizes that a reference to medical literature alone, without a discussion of the specific facts as to causation or etiology does not provide competent evidence sufficient to support a medical nexus opinion. See Libertine v. Brown, 9 Vet. App. 521, 523 (1996). Finally, the examiner opined that "the claimed [low back] condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness." No rationale was provided to support a finding that the condition clearly and unmistakably existed prior to service. The Board finds the September 2021 VA medical opinion. Remand is warranted for a new VA addendum opinion that fully addresses this matter. The matter is REMANDED for the following action: 1. Obtain a VA addendum medical opinion from the appropriate clinician concerning the nature and etiology of the Veteran's current and recent back disabilities. The claims file, including a copy of this remand, should be reviewed by the examiner. A discussion of the complete rationale for all opinions expressed should be included in the examination report, to include reference to pertinent evidence where appropriate. If an opinion cannot be rendered without an examination, then a VA examination should be scheduled and conducted. After careful review of the record, the VA examiner should identify the lumbar spine disability/disabilities present during the appeal. Then, the examiner should provide the following opinions: a. Did a lumbar spine disability clearly and unmistakably (undebatable) preexist a period of the Veteran's service? b. If the examiner finds a disability did clearly and unmistakably preexist service, the examiner must opine whether it was clearly and unmistakably not aggravated by service. c. If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. In providing this opinion, the examiner should consider the Veteran's lay statements that: carrying heavy combat loads of 70 pounds or more over rough terrain during repeated conditioning hikes, tactical movement, exercises, and deployments affected his back; and ill-fitting service footwear and standing in formations on hard surfaces and close order drill over a period of years impacted his back. The examiner is advised that the Veteran is competent to report her symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If her reports are discounted, the examiner should provide a reason for doing so. An absence of medical evidence cannot be the sole basis for a negative opinion. d. Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's service-connected bilateral foot disabilities (bilateral plantar fasciitis, right foot hallux valgus, left foot hallux valgus) caused or aggravated his lumbar spine disability? For the purposes of secondary service connection, the examiner is advised that aggravation is defined as "any increase in disability." See Allen v. Brown, 7 Vet. App. 439, 448 (1995). All opinions must be supported by a sufficient rationale. If any requested opinion cannot be provided without resort to speculation, the examiner should explain whether the inability to provide the opinion is due to the limits of the examiner's medical knowledge, the limits of medical knowledge in general, or there is additional evidence that would permit the opinion to be provided. K.R. FLETCHER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A.N., 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.