Citation Nr: 21010226 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 14-10 665A DATE: February 24, 2021 REMANDED Entitlement to service connection for a neck disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from March 2003 to May 2008. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 Department of Veterans Affairs (VA) rating decision. In October 2016, a Travel Board hearing was held before the undersigned. In November 2017, December 2018, and August 2020, the case was remanded to the agency of original jurisdiction (AOJ) for further development. Entitlement to service connection for a neck disability Unfortunately, there has not been substantial compliance with the Board’s previous remand directives, and consequently another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The August 2020 Board remand directed that the examining consultant provide an etiological opinion regarding the Veteran’s neck disability, and in so doing note both the October 2018 private chiropractor’s opinion and the Veteran’s accounts that he has had neck pain since service. In a September 2020 VA opinion, the provider stated that the Veteran currently had a diagnosis of degenerative disc disease (DDD) of the cervical spine, which was known to be a “chronic, progressive, multifactorial condition associated with wear and tear over time and advancing age.” While she indicated that she had reviewed the October 2018 chiropractor’s opinion and “statements in support of claim,” she concluded that the Veteran’s neck condition was unrelated to service due to “the lack of evidence of chronicity and continuity of symptoms during the 9 years between [his] separation from service in 2008 and the C spine X-rays in sept 2017 diagnosing Degenerative disc disease at C5-6.” This opinion is deficient because the provider appeared to rely (impermissibly) on the absence of documentary evidence of chronicity and continuity of his neck disability. The provider did not address the Veteran’s lay statements of neck pain since separation from service. See Dalton v. Peake, 21 Vet. App. 23 (2007) (a medical opinion based solely on the absence of documentation in the record is inadequate; a medical opinion is inadequate if it does not consider the Veteran’s reports of symptoms and history). Therefore, a remand for an addendum opinion is necessary. The Board also notes that in an October 2016 opinion, a private orthopedic surgeon, JOK, DO, who found it “more medically probable than not” that the Veteran’s cervical spine condition was related to service, relied in part upon a March 22, 2016 statement by a past roommate of the Veteran. That statement has not been associated with the claims file. The matter is REMANDED for the following action: 1. Ask the Veteran to submit the roommate’s (BB) statement dated March 22, 2016 (reportedly describing the Veteran’s neck pain when they were roommates), which was cited by Dr. JOK in his October 24, 2016 report. 2. Then, arrange for the Veteran’s claims file to be returned to the September 2020 examiner, for an addendum advisory medical opinion regarding the etiology of the Veteran’s neck disability. [If the September 2020 examiner is unavailable or unable to provide the addendum opinion sought, forward the record to another appropriate clinician (in orthopedics) for review and the opinion sought.] The examiner is asked to respond to the following: (a). Identify the likely etiology for the Veteran’s diagnosed cervical DDD. Specifically, is it at least as likely as not (a 50% or greater probability) that it was incurred in service, to include as due to repetitive trauma in physical training (to include parachuting) and other activities therein? (b). Specifically consider/address the Veteran’s lay statements in the record indicating that he has had continuous neck symptoms since service, and opine how the statements comport with generally accepted medical norms. (E.g., is his diagnosed DDD consistent with a process arising from trauma during service?) If the statements are rejected as not credible, identify/explain the clinical findings/medical principles that support that conclusion. The consulting provider is advised that absence of documentation of a neck disability during or soon after service cannot be the only basis for rejecting a possible nexus to service, but that providing an [alternate] likely etiology, beyond any assertion that there was no documentation of neck symptomatology at the military separation examination and for nine years after service, may overcome this. All opinions must include rationale that cites to supporting factual data and medical principles. If an opinion sought cannot be given without resort to mere speculation, the consulting provider should explain whether the need to speculate is due to a deficiency in the state of general medical knowledge or by a deficiency in the record or the examiner (additional facts are required, or the examiner lacks the requisite knowledge or training). If such is the case, the consulting provider should identify the further testing/specialist’s opinion/other information needed for the opinion sought. . GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chu, 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.