Citation Nr: 21074764 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 17-29 244 DATE: December 16, 2021 REMANDED The appeal regarding entitlement to service connection for a cervical spine disability is remanded. REASONS FOR REMAND The Veteran had active service from July 2008 to December 2011. This matter comes before the Board of Veterans' Appeals (Board) from a September 2013 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in May 2021. A transcript is of record. The Board remanded the appeal in August 2021. While the appeal was in remand status, the AOJ issued an October 2021 rating decision that granted service connection for left and right ankle disabilities and left and right shin splints. These awards constitute a full grant of the benefits sought on appeal. The remaining issue of entitlement to service connection for a cervical spine disability has been returned to the Board. In the August 2021 remand, the Board directed that an opinion be obtained regarding the etiology of the Veteran's claimed cervical spine disability. The Board indicated that the opinion should consider the Veteran's April 2009 report of neck pain and his March 2012 complaint of back pain extending into his neck. It also directed that an opinion be obtained regarding whether the claimed cervical spine disability was caused or aggravated by the Veteran's service-connected lumbar spine disability. In September 2021, an examiner opined that the Veteran's cervical strain was not proximately due to or the result of his service-connected lumbar spine disability. He did not provide an opinion regarding whether the claimed cervical spine disability was aggravated by the service-connected lumbar spine disability. This question must be addressed by an additional examination. Regarding a relationship to service, the examiner indicated that there was no relationship between the Veteran's current neck complaints and a chronic neck condition related to service. He reasoned in part that there was no evidence in the service treatment records of an ongoing neck condition with onset during service. This reasoning does not adequately consider the Veteran's report of symptoms during service and in the years thereafter. On examination, the Veteran's competent reports must be considered. The examiner also indicated that the referenced March 2012 complaint of back pain extending into the neck did not correlate with any specific chronic or separate neck condition; rather, he indicated that the paraspinal muscles extended to the neck and were likely the cause of the Veteran's neck symptoms from a clinical perspective. In this regard, the Board observes that pain alone can constitute a disability if it causes functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1365068 (Fed. Cir. 2018). On examination, the question of whether the Veteran has experienced disabling functional impairment must also be considered. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of his cervical spine disability, to include any functional limitation due to pain. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all conditions referable to his cervical spine, to include whether he has functional limitation due to cervical spine pain. The examiner should provide an opinion regarding whether it is at least as likely as not that any such disability is related to active service. The examiner should specifically consider the Veteran's report of neck pain in service (including an April 2009 report of pain in the neck and a March 2012 report of back pain extending into the neck) together with his reports of pain in the years following service. The examiner should also provide an opinion with respect to whether it is at least as likely as not that any such disability was caused or aggravated by the Veteran's service-connected lumbar spine disability. In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the 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. 2. Then, readjudicate the Veteran's claim. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.