Citation Nr: 21007497 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 19-32 901 DATE: February 9, 2021 REMANDED Entitlement to service connection for a back/spine disability is remanded. Entitlement to service connection for a neck/cervical spine disability is remanded. Entitlement to service connection for loss of hand use is remanded. Entitlement to service connection for disability manifesting in decreased fine motor skills, right upper extremity is remanded. Entitlement to service connection for disability manifesting in decreased fine motor skills, left upper extremity is remanded. Entitlement to service connection for disability manifesting in decreased gross motor skills, right lower extremity is remanded. Entitlement to service connection for disability manifesting in decreased motor skills, left lower extremity is remanded.   REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1957 to December 1959. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In December 2020, the Veteran presented testimony at a virtual Board hearing held before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record. Further development is found necessary prior to adjudication of these matters. In the present case, the Veteran’s service treatment records were requested from the National Personnel Records Center (NPR), which responded that such records were “fire-related” (referring to a fire at the NPRC in 1973) and therefore unavailable. When a veteran's service treatment records are unavailable, VA's duty to assist and the Board's duty to provide reasons and bases for its findings and conclusions and to consider carefully the benefit-of-the-doubt rule are heightened. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). 1. Entitlement to service connection for a back/spine disability is remanded. 2. Entitlement to service connection for a neck/cervical spine disability is remanded. At the December 2020 hearing, the Veteran testified that he started going to a chiropractor for increased pain in the late 1960s, and continued such treatment for 30 years. He further testified that he’d been seen by a number of chiropractors in the Boston area, one in Newton, and one in the Waltham area, as well as a primary care doctor and specialists based out of the Newton-Wellesley Hospital area. While a few private treatment records have been associated with the claims file, including records from a Dr. O.A. from November 2010-June 2011, and imaging reports from May 2005 and October-December 2016, the vast majority of the Veteran’s relevant private treatment records remain outstanding. It does not appear that VA has yet made attempts to obtain such treatment records. As such records may help the Board develop a better picture of the Veteran’s medical history, particularly given the fact that more than 50 years have passed since the described in-service injury, the Agency of Original Jurisdiction (AOJ) should take all reasonable action to request these records and associate them with the claims file. The Veteran has not yet been provided with VA examination and medical opinion concerning the issues of entitlement to service connection for a spine and neck disability. While the claims file contains an April 2017 examination for housebound status or permanent need for aid and attendance report that includes a private physician’s statement that 2016 cervical spine X-rays/CT scan “show evidence of old damage likely from military service,” the lack of explanatory rationale for this conclusion or discussion of the Veteran’s prior medical history is found to render the opinion insufficient, alone, for a grant of service connection at this time. In order for the Board to make a fully-informed decision on the issues of entitlement to service connection for a back/spine and neck/cervical spine disability, examination and medical opinion is found needed. 3. Entitlement to service connection for loss of hand use is remanded. 4. Entitlement to service connection for disability manifesting in decreased fine motor skills, right upper extremity is remanded. 5. Entitlement to service connection for disability manifesting in decreased fine motor skills, left upper extremity is remanded. 6. Entitlement to service connection for disability manifesting in decreased gross motor skills, right lower extremity is remanded. 7. Entitlement to service connection for disability manifesting in decreased motor skills, left lower extremity is remanded. Because a decision on the remanded issues of entitlement to service connection for back and neck disabilities could significantly impact a decision on the issues of entitlement to service connection for disability manifesting in decreased fine motor skills of the right and left upper extremities, decreased gross motor skills of the right and left lower extremities, and loss of hand use, the issues are inextricably intertwined. A remand of the latter claims is therefore also needed. The matters are REMANDED for the following action: 1. Ask the Veteran to identify and complete a VA Form 21-4142 for any relevant outstanding private treatment records he wishes VA to obtain on his behalf, including but not limited to those from chiropractors from the late 1960s to the present; Dr. W.C. with Patient First Chiropractic and Physical Therapy; and Dr. W. H. with Newton-Wellesley Hospital. Make two requests for the authorized records from the private physicians/facilities, unless it is clear after the first request that a second request would be futile. 2. After associating all responsive records with the claims file, schedule the Veteran for a VA examination for his claimed back and neck disabilities, and associated upper and lower extremity neurological impairments. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. For purposes of providing the below opinions, the examiner is to proceed under the assumption that the in-service train incident described by the Veteran at the December 2020 hearing in fact occurred as described (despite the unavailability of service treatment records). The examiner is asked to provide a response to the following: 1. Identify a diagnosis for any back/spine disability present at any point during the relevant appeal period (March 2018 to present). Is the disability at least as likely as not related to service, including the described incident where the Veteran was bodily thrown against a train’s wall during a violent and sudden train coupling process? 2. Identify a diagnosis for any neck/cervical spine disability present at any point during the relevant appeal period (March 2018 to present). Is the disability at least as likely as not related to service, including the described incident where the Veteran was bodily thrown against a train’s wall during a violent and sudden train coupling process? 3. Identify a diagnosis for any disability manifesting in decreased gross motor control of the left and/or right lower extremities. Is the disability at least as likely as not caused by the Veteran’s back/spine disability? 4. Identify a diagnosis for any disability manifesting in decreased fine motor control of the Veteran’s left and/or right upper extremities. Is the disability at least as likely as not caused or aggravated beyond its natural progression by the Veteran’s neck/cervical spine disability? A rationale must be provided for any opinion expressed. In providing the requested opinions, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 3. After completing the above, and conducting any further development deemed necessary in light of the expanded record, issue the Veteran and his representative a supplemental statement of the case and allow them an opportunity to respond before returning the appeal to the Board for further appellate review, if in order. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Solomon, 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.