Citation Nr: 21076061 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 14-30 469 DATE: December 22, 2021 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a skin condition on the back is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1989 until July 1989 and from November 1990 until May 1991. He also had additional service with the Louisiana Army National Guard. In March 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This appeal has been before the Board on several prior occasions, most recently in August 2021. Unfortunately, there has not been substantial compliance with the prior remand directives and another remand is now required. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a skin condition on the back is remanded. The claims must be remanded again because the addendum medical opinions obtained in October 2021 are inadequate for adjudication. The clinician offered a negative nexus opinion for each condition, but improperly relied upon an absence of documented medical treatment or diagnosis as affirmative evidence the Veteran's conditions did not begin in service. The Veteran is competent to report his own symptoms including when they first arose and if he has experienced continuity of symptomatology since. The absence of a diagnosis does not mean the absence of a condition. A lack of diagnosis or documentation of treatment cannot be the basis for a negative opinion. In remanding this issue, the Board does not make a preliminary formal finding as to the credibility of the Veteran's report of in-service injuries and onset. Rather, the Board merely requests that, on remand, the clinician accept the Veteran's testimony and lay statements for purposes of the medical nexus opinion. See Smith v. Wilkie, 32 Vet. App. 332, 337 (2020). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician who has not previously opined on the likely etiology of the Veteran's back condition. The opinion provider should be provided with all pertinent records. If the opinion provider determines an opinion cannot be made without examination of the Veteran, one should be scheduled. After a review of the record and any additional examination or testing, if necessary, the clinician should answer the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed lumbosacral strain is related to his active service? In answering the foregoing, the examiner should consider, and discuss as appropriate, the following: (i) the Veteran's report that he suffered a back injury in service for which he sought medical treatment at a hospital on Fort Hood and was told he pulled a muscle; (ii) a motor vehicle crash after the Veteran left service in which his back was injured; and (iii) the Veteran's testimony that his back continues to hurt. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, they must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise; or whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Obtain an addendum medical opinion from an appropriate clinician who has not previously provided an opinion on the likely etiology of the claimed skin condition of the back. The opinion provider should be provided with all pertinent records. If the clinician determines that a requested opinion cannot be provided without examination of the Veteran, one should be scheduled. After a review of the file and any additional required examination or testing, the clinician is asked to answer the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran's diagnosed acne on the back is related to his active service? In answering the above, the opinion provider should consider the Veteran's sworn testimony that the skin condition began in service, was treated with over-the-counter medications, and that he eventually sought medical treatment when the condition worsened. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, they must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise; or whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. Collins, 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.