Citation Nr: 21076672 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 16-06 903 DATE: December 27, 2021 REMANDED Entitlement to service connection for a cervical spine disorder is remanded. REASONS FOR REMAND The Veteran honorably served on active duty from February 1971 to November 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, December 2019, and March 2021, the Board remanded the claim for further development. Specifically, in the March 2021 Remand, the Board directed that the RO obtain a supplemental etiological opinion. Upon reviewing the opinion, dated April 2021, the Board determines that the RO has not substantially complied with the Board's remand instructions. Thus, further remand is required. As outlined in its March 2021 remand order, the Board specifically notes the Veteran's report that he began experiencing problems with his cervical spine during service and such problems have continued since then to the present day. The Board also notes the August 2019 examination report reflected diagnoses of degenerative arthritis, intervertebral disc syndrome, and bilateral upper extremity radiculopathy, all diagnosed in 2003. In the August 2019 examination report, the examiner indicated that the Veteran's symptoms of a cervical neck disorder began in 1997. The Board observed that the Veteran reported that his symptoms have progressively worsened since 1997, while reiterating the Veteran's report that his symptoms began during military service, to include neck pain with numbness and tingling, achy, throbbing pain and stiffness, pain radiating down extremities to fingers and limited motion. The Board further noted that the record reflects that the Veteran's private physician treated his neck disorder since 1990. Given this favorable evidence not adequately discussed in the August 2019 report, the Board requested a supplemental opinion. Unfortunately, in the April 2021 report, the examiner has not even acknowledged any of the discussed evidence, contrary to the Board's directive that "the examiner must consider the full record, including service treatment records, pertinent post-service treatment records, and lay statements from the Veteran concerning the onset and continuity of his symptoms." Instead, the April 2021 examination report reflects an examiner's conclusion that the "Veteran did not start complaining of neck pain until 2007," explaining that "the medical record dated 3/20/2007 noted veteran with neck pain that started two months prior." To that end, an October 2003 MRI report alone indicating the multilevel degenerative changes, most pronounced at C5-6, as noted in the MRI report, the August 2019 examination report, and the March 2021 Board's remand, undermines the examiner's opinion apparently formed on a single treatment note taken out of context of the evidence of record. A medical opinion that is based on incomplete facts has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Accordingly, the matters are REMANDED for the following action: Obtain an addendum opinion (from an appropriate clinician who has never examined the Veteran) as to the etiology of the Veteran's neck disability. If an in-person examination is necessary to answer the Board's questions, one must be provided. The examiner is asked to answer the following questions: a) Is it at least as likely as not (meaning probability of 50 percent or greater) that the Veteran's cervical spine disorder had its onset in or is otherwise etiologically related to his service? Why or why not? b) Is it at least as likely as not (meaning probability of 50 percent or greater) that the Veteran's cervical spine disorder was proximately caused or aggravated (meaning made worse) by his service-connected lumbar spine disability? Why or why not? In forming the opinion, the examiner MUST review the entire claims file, to include the March 2021 Board's remand order (marked "03/18/2021 BVA Decision") and this order explaining the reasons why the previous medical opinions of record were found inadequate. In formulating the opinion, the examiner MUST expressly discuss the Veteran's lay statements as to the onset and continuity of symptomatology. The examiner should abstain from making credibility determinations and should address the soundness of the Veteran's lay statements only from a medical perspective. (CONTINUED ON NEXT PAGE) The examiner should provide thorough and sound rationale for every conclusion reached, avoiding generalized conclusory statements, clearly citing to any medical authority relied upon and connecting any general medical knowledge to the Veteran's specific circumstances. TIFFANY HANSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alex Bardin, 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.