Citation Nr: 21006413 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 13-34 230A DATE: February 4, 2021 REMANDED Entitlement to service connection for a neck disability, to include as secondary to a left shoulder disability and/or posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for a back disability, to include as secondary to a left shoulder disability and/or posttraumatic stress disorder (PTSD), is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active duty service from September 1967 to April 1971. This appeal comes to the Board of Veterans’ Appeals (Board) from a rating decision, dated July 2011, issued by a Department of Veterans Affairs (VA) Regional Office (RO). In its decision, the RO denied service connection for posttraumatic residual cervical and degenerative disc disease and spondylosis (claimed as cervical). The RO also denied service connection for posttraumatic residual degenerative joint disease lumbar spine (claimed as lumbar). The Veteran timely appealed. The Board notes that the TDIU issue was not expressly raised in prior rating decisions, but was reasonably construed as a request for TDIU based on the record. Rice v. Shinseki, 212 Vet. App. 447 (2009). The Veteran’s appeal has previously been before the Board. In October 2017, the Board remanded the Veteran’s neck and back disability claims to the AOJ for additional development. In December 2019, the Board remanded the Veteran’s neck and back disability claims and the TDIU claim to the AOJ for additional development. 1. Entitlement to service connection for a neck disability, to include as secondary to a left shoulder disability and/or PTSD, is remanded. 2. Entitlement to service connection for a back disability, to include as secondary to a left shoulder disability and/or PTSD, is remanded. Although the Board regrets the additional delay, the Veteran’s remaining claims must be remanded before the Board is able to adjudicate this case on the merits. Specifically, the Veteran’s representative has raised a theory of service connection that has not been developed. In a June 2017 appellate brief, the Veteran’s representative noted, The Veteran has arthritis in the neck and lumbar spine…In the opinion of a licensed psychologist, Dr. [W. E.], objective testing on October 26, 2010 indicates that ‘individuals with similar profiles present themselves as physically ill…They worry excessively and display high physiological reactivity. The physical symptoms are likely related to underlying emotional problems.’ The Veteran is service connected for PTSD…Part of the issue is the psychosomatic effects of PTSD. The Veteran’s representative then goes on to cite several articles discussing the psychosomatic effects of PTSD, to include arthritis. He closed by saying, The Veteran has worked at only non-physical jobs since shortly after leaving the Air Force. It is a safe assumption that he was not running and diving for cover during mortar and rocket attacks after Vietnam. When you are running for the fox hole or bunker under fire you don’t much care how you do it so long as it is fast. There also is no evidence of any work-place injuries to the back or neck. The Veteran underwent a private examination in December 2010. The physician wrote an opinion for both the Veteran’s neck and back disabilities. He provided, “The Veteran’s left shoulder (service-connected) was injured at George AFB in California, details of which are on file with the VA. At the same time that his shoulder was injured, [he] also sustained injury to his neck and low back.” Following his physical evaluation, he concluded, “It is more likely than not that same is directly and causally related to the service connected accident that injured [his] left shoulder. It is accordingly more likely than not that the same is directly and causally related to his military service.” While the private physician based his opinion on the fact that the Veteran injured his neck and low back during the same in-service incident which injured his left shoulder, the Veteran’s service treatment records (STRs) show no evidence of complaints of or treatment for a neck or back injury while in service. Therefore, in an October 2017 decision, the Board remanded the Veteran’s neck and back disability claims for a VA examination to address the Veteran’s claim that he injured his low back and neck, in addition to his left shoulder, while in service. Thereafter, the Veteran was provided VA examinations in March 2018 and May 2019. The VA examiners provided negative nexus opinions for the theory of direct service connection for the Veteran’s neck and back disabilities. The May 2019 VA examiner also provided negative nexus opinions for the theory that the Veteran’s service-connected left shoulder disability caused his neck and back disabilities. In a December 2019 decision, the Board remanded the Veteran’s neck and back disability claims in order to obtain an addendum opinion as to whether the Veteran’s service-connected left shoulder disability aggravated his neck and back disabilities. The Veteran was then provided another VA examination in May 2020. The VA examiner provided negative nexus opinions for the theory that the Veteran’s service-connected left shoulder disability aggravated his neck and back disabilities. As discussed above, the Veteran has also asserted that his neck and back disabilities may be secondary to his service-connected PTSD. See Appellate Brief dated June 2017. However, none of the VA examinations that have been provided have addressed this theory of secondary service connection. Therefore, the Board finds that a remand is required in order to obtain an opinion as to whether the Veteran’s service-connected PTSD caused or aggravated his current neck and back disabilities. 3. Entitlement to a TDIU is remanded. Although the Board regrets the additional delay, the Veteran’s TDIU claim must also be remanded before the Board is able to adjudicate this issue on the merits. Because a decision on the remanded issues of entitlement to service connection for a neck disability and a back disability could significantly impact a decision on the issue of TDIU, the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (holding two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Accordingly, the matters are REMANDED for the following action: 1. Request an addendum opinion addressing the Veteran’s neck and back disability claims. In-person examination is not required unless deemed necessary by the examiner. Based upon a review of the entirety of the claims file, the examiner is requested to provide an opinion as to the following questions: (a.) Please identify any neck disability present at any time since the date the Veteran filed his claim (November 29, 2010). (b.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran’s PTSD caused his current neck disability? (c.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran’s PTSD aggravated (worsened beyond the natural progression) his current neck disability? (d.) Please identify any back disability present at any time since the date the Veteran filed his claim (December 21, 2010). (e.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran’s PTSD caused his current back disability? (f.) Is it at least as likely as not (probability of 50 percent or greater) that the Veteran’s PTSD aggravated (worsened beyond the natural progression) his current back disability? (e.) After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of TDIU. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case (SSOC) and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. 2. Explanations for all opinions must be provided. In providing the requested rationale, the examiner is asked to cite to the pertinent evidence of record, including clinical records and the Veteran’s statements regarding the onset of his symptoms. Emily Tamlyn Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Bristor 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.