Citation Nr: 21006134 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 20-11 634 DATE: February 3, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to a compensable initial evaluation for urticaria is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1978 to March 1985. 1. Entitlement to service connection for a back disability is remanded. The claim is remanded to obtain an adequate medical opinion. On a September 2017, the examiner diagnosed degenerative arthritis of the spine and concluded the back condition was less likely related to service. There was objective evidence in the record of the injury occurring; however, there were no records indicating chronicity of care or chronic condition. Spondylitic changes on radiographs in September 2017 were noted to be age appropriate. Thereafter, the Veteran’s representative submitted citations to articles arguing that osteoarthritis often develops slowly, over a long period of time and that once any initial symptoms of an injury resolve, osteoarthritis is likely to have been incurred or accelerated. Further, the report of a July 2020 private magnetic resonance imaging (MRI) noted that there was chronic back pain and potential shrapnel in the back. As such, another VA medical opinion, taking into consideration medical literature identified by the Veteran’s representative. The July 2020 MRI identifies a treatment provider, but no related treatment records from that provider. On remand, the Veteran must be asked to identify all relevant outstanding private treatment records. On remand, the Veteran should be asked to identify all providers and then obtain any identified records. 2. Entitlement to a compensable initial evaluation for urticaria is remanded. The claim must be remanded for a new examination because the Veteran has credibly argued that his condition has increased in severity since the last VA examination in September 2017. In his February 2018 Notice of Disagreement the Veteran reported that he has irritation of the back to the point of impact on a daily basis. The Veteran’s representative noted that the Veteran indicated that his condition causes irritation on his back almost daily, with worsening symptoms when the weather is humid. See March 2020 statement. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all relevant outstanding treatment records. Thereafter, after obtaining any necessary authorization, attempt to obtain and associate with the claims file all identified treatment records. 2. After completion of the above, forward copies of all pertinent records to a VA clinician to obtain a medical opinion regarding the nature and etiology of the Veteran’s degenerative arthritis of the back. If examination is deemed necessary to respond to the questions presented, one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner must answer the following question: Is it at least as likely as not that the Veteran’s diagnosed back disability is directly related an explosion in service or possible shrapnel from the explosion in service? In rendering the opinion, the examiner must comment on (i) the prior VA examination report; (ii) medical literature identified by the Veteran, and; (iii) the July 2020 MRI. A complete rationale must be provided for any opinions offered. 3. Thereafter, schedule the Veteran for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) by an appropriate clinician to determine the current severity of his service-connected urticaria. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. A complete rationale must be provided for any opinions offered. M.E. LARKIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Robert J. Burriesci, 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.