Citation Nr: 21074143 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-39 408 DATE: December 14, 2021 REMANDED Entitlement to service connection for a neck disorder is remanded. REASONS FOR REMAND The Veteran served in the Army National Guard with active duty from August 1988 to November 1988 and from November 1990 to June 1991. This case is before the Board of Veterans' Appeals (Board) on appeal from an October 2012 Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement service connection for cervical disc disease. The Veteran's notice of disagreement (NOD) was received in November 2012. The RO issued a statement of the case (SOC) in June 2017. The Veteran's VA Form 9, substantive appeal to the Board, was received in July 2017. In August 2021, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of the testimony is associated with the claims file. After review of the evidence of record, a remand for further development is necessary prior to adjudicating the claim on appeal. In this regard, the Veteran asserts that he has a current neck disorder that had its onset during active service. Specifically, he contends that his neck was injured in service when a tent pole hit his neck in 1991 and he has experienced neck problems ever since the incident in service. The evidence shows that the Veteran has a current diagnosis of degenerative disc disease of the cervical spine. His service treatment records document that a tent pole hit the Veteran in the upper back/neck in February 1991 and he was diagnosed with contusion of upper back and neck. The Veteran underwent a VA examination in May 2012. In September 2012 an orthopedic surgeon provided the VA medical opinion that it is less likely than not that the Veteran's injury in 1991 caused his present cervical spine condition. The orthopedic surgeon provided a clear explanation in support his opinion. However, the medical opinion is incomplete as the orthopedic surgeon did not address the Veteran's lay statements as to the onset his neck symptoms and continuous or recurrent nature of such symptoms to the present. Although the Veteran submitted a medical opinion from his VA nurse practitioner, this opinion is of low probative value as the VA nurse practitioner determined that "[i]t is possible that the [Veteran's] current neck pain and chronic bony changes are related the active duty incident." This opinion is speculative and inconclusive as the VA nurse practitioner prefaced the opinion with the word "possible" without any other supporting data or evidence. Accordingly, a remand is necessary to obtain new VA medical opinion. The matters are REMANDED for the following action: Obtain a medical opinion for the service connection claims for a neck disorder from an appropriate medical specialist, preferably, an orthopedist or neurosurgeon, if possible. Only arrange for the Veteran to undergo an examination if deemed necessary in the judgment of the medical specialist designated to provide the medical opinion. The entire, electronic claims file to include a complete copy of this REMAND must be made available to the designated individual, and the medical opinion report should include discussion of the Veteran's documented history and assertions. If the Veteran is examined, all indicated tests and studies should be accomplished (with all results made available to the examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The medical specialist is requested to address or provide an opinion as to whether it is at least as likely as not (i.e. a 50 percent or greater probability) that the Veteran's degenerative disc disease of the cervical spine and any other neck disorder documented in the medical records during the appeal period had its onset in or is otherwise related to or in part caused by the Veteran's active military service, to include the documented in-service treatment for the upper back and neck injury during service. In rendering each requested opinion, the medical specialist must consider and discuss all service treatment records and post-service medical and other objective evidence of record. The medical specialist should specifically address the following: the March 1991 line of duty determination, April 1991 service treatment record, April 1991 separation examination, April 1991 report of medical history form, May 1991 service treatment record, March 1994 VA spine examination, May 2012 VA examination, September 2012 VA medical opinion, and the May 2013 medical opinion from the Veteran's VA nurse practitioner. The medical specialist also must consider and discuss all lay assertions, to include any assertions as to in-service events, and as to the nature, onset, and continuity of symptoms. (Continued on the next page) Notably, the absence of documented evidence of a specific disability or associated symptoms during and shortly after service should not, alone, serve as the sole basis for a negative opinion. In this regard, the medical specialist is advised that the Veteran is competent to report his observable symptoms and history, and such reports must be specifically acknowledged and considered in formulating opinions. If lay assertions in any regard are discounted, the medical specialist should clearly so state, and explain why. In providing the requested opinion, the clinician should consider the Veteran's reported injury and symptoms in service and thereafter, including the nature of his reported injury and the onset, progression and severity of his reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Berry, 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.