Citation Nr: 21077571 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 19-08 880A DATE: December 30, 2021 REMANDED Entitlement to service connection for a back condition is remanded. Entitlement to service connection for a groin disorder (claimed as epididymitis, hardening of the testicles and groin pain) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1969 to September 1973. These matters are before the Board of Veterans' Appeals (Board) on appeal of an August 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Boston, Massachusetts. In January of 2021, the Veteran presented testimonial evidence at a videoconference hearing before the undersigned Veterans Law Judge. A transcript is of record. 1. Entitlement to service connection for a back condition is remanded. The Veteran claims that he is entitled to service connection for a back condition. He has asserted that when he was about to board his ship in-service, he instead "slid and I hit my back against the, the, I think it was the curb". See January 2021 Board Hearing Transcript. Thereafter, the family members who were intending to drop him off instead drove him to a hospital for treatment and "the hospital told me that I actually had a hairline fracture in my L4." Further, "It was '73, where I had a back issue and they just basically gave me Ibuprofen with Tylenol and, and sent me home. Since that point in time, I've been, you know, basically handling this on my own until probably about 20 years ago where I had episodes where I just, there was times where I was actually unable to walk." As such, the Veteran has seemingly contended that his back condition onset during service and has essentially continued through the present. A nexus opinion was obtained from a VA examiner in August of 2017. In reaching a negative conclusion, the examiner offered as rationale that "the Veteran claims a back condition and contends service connection based on a documented episode of a back problem during active duty. The evaluation today confirms the back condition. A review of the STR shows that the back problem was evaluated as a soft tissue injury, or contusion. The inference of the diagnosis of soft tissue injury is that no more serious injury to the bones or other structures of the back was identified. There is no information of which I am aware that would call this diagnosis into question. The usual natural history of a soft tissue injury is to resolve without chronic sequelae. It is unlikely that a soft tissue injury would be the cause of a chronic, ongoing lifelong disability condition. There is no information of which I am aware that would establish that the soft tissue injury in this case followed anything other than the usual course. It is likely that the soft tissue injury in this case resolved without causing a chronic, ongoing condition. It is possible that the documented in-service injury caused a chronic disability back condition. But it is unlikely. It is my opinion that it is less likely than not (less than fifty percent probability) that the present claimed condition of back condition is due to and caused by any in-service event, injury, or illness, including the documented soft tissue injury of the back documented during active duty." The Board finds this rationale to be insufficient for multiple reasons. In particular, the assertion that "it is possible that the documented in-service injury caused a chronic disability back condition" directly conflicts with the conclusion that "the present claimed condition of back condition is due to and caused by any in-service event, injury, or illness, including the documented soft tissue injury of the back documented during active duty". Further, the Board takes issue with the assertion that "the inference of the diagnosis of soft tissue injury is that no more serious injury to the bones or other structures of the back was identified. There is no information of which I am aware that would call this diagnosis into question. The usual natural history of a soft tissue injury is to resolve without chronic sequelae." As noted above, the Veteran himself has attested that his condition has been ongoing and that it did not in fact resolve which constitutes competent and relevant "information". See e.g. January 2021 Board Hearing Transcript. Additionally, the Board generally notes that while soft tissue injuries may in fact resolve, they may also become chronic, especially without proper treatment which the Veteran in this case admits he did not continue with for years post-service. Thus, the August 2017 VA opinion is based on an incomplete factual basis without consideration of the Veteran's lay statements and provides an insufficient basis upon which to decide the claim. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (examination inadequate where examiner did not comment on report of in-service injury and relied on lack of evidence in service medical records to provide a negative opinion). Therefore, a remand for an addendum opinion is necessary. 2. Entitlement to service connection for a groin disorder is remanded. The Veteran has also contended that service connection is warranted for a groin condition. More specifically, he has stated that "I was treated at the US Public Health Service Hospital in Brighton, to treat an infection on my feet during active duty. And to today I continued to be treated for my feet. And like I said, I, I feel that they're directly related to each other with the feet and the epididymitis." Notably, the Veteran is already service-connected for tinea pedis (foot rash). However, in addition to the August 2017 VA opinion of record containing rationale that is flawed for reasons similar to those outlined above in regard to the one relevant to his asserted back claim, the opinion in regard to his groin condition does not consider whether service connection is warranted on a secondary basis. The VA opinion indicated that "there is no information of which I am aware that would establish that the epididymitis condition was recurrent during active duty". However, the Veteran's service treatment records contain multiple notations that appear relevant and may in fact demonstrate the recurrence and/or continuation of the alleged groin condition. A June 1973 notation, for example, indicates that the Veteran presented with complaints in the "bilateral nodes groin area". It was noted that "Pt went out to [B.] for fungus on feet diagnosed as [illegible] yeast infection. Pt went to [B.] for nodes on Monday 18 June 73 and was told nodes caused by staph infection" and "Pt into sick bay Monday afternoon given undecylenic acid as ordered by [doctor] for foot condition." A notation from the following month in July 1973 indicates that the Veteran returned with "swelling R testicle since yesterday". Therefore, the Board cannot make a fully-informed decision until another VA opinion is obtained that contains a sufficient rationale based on an accurate assessment of the Veteran's medical history and that concurrently addresses the Veteran's specific contentions and theories of entitlement. The matters are REMANDED for the following actions: 1. Ask an appropriate VA clinician(s) to review the Veteran's file regarding his claimed (i) back condition and (ii) groin condition. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the VA clinician(s). The entire claims file, including a complete copy of this remand, should be made available to and be reviewed by each clinician, and it should be confirmed that such records were available for review. Following a review of the evidence of record, to include the Veteran's lay statements, each clinician should answer the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that any (i) back condition or (ii) groin condition had its onset during active duty or is causally or etiologically related to any in-service event, disease, or injury OR within one year of his departure from active duty. In so opining, the clinician is asked to reconcile the Veteran's assertions of ongoing back symptomology that he self-treated for years. (b.) If and only if (a) is not answered in the affirmative in regard to the claimed groin condition, then the clinician is additionally asked to opine whether it is at least as likely as not (50 percent or greater probability) that the claimed groin condition is (1) proximately due to OR is (2) aggravated beyond its natural progression by the Veteran's service-connected tinea pedis condition. If aggravation is shown, the clinician should quantify the degree of aggravation, if possible. In so opining, the clinician is asked to reconcile the Veteran's assertions that his groin condition onset subsequent to his foot condition AND the multiple groin-related service treatment record notations, including from June 1973 and July 1973. A complete rationale must be provided for all conclusions. 2. Thereafter, readjudicate the claims. If the benefits sought on appeal remain denied, issue a supplemental statement of the case to the Veteran and his representative. Then return the appeal to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Smith, 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.