Citation Nr: 21013687 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 15-06 693A DATE: March 10, 2021 REMANDED Entitlement to service connection for a low back disability, to include as secondary to service-connected left leg disabilities, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps from July 1973 to April 1981. The Veteran testified at a hearing before a Veterans Law Judge (VLJ) in May 2019. A transcript of that hearing is of record. When that VLJ retired from employment with the Board, a January 2021 letter was sent requesting clarification whether the Veteran wanted a new hearing. The letter informed the Veteran that he was entitled to another hearing with a different VLJ or, if he did not respond within thirty days, the Board would assume that he does not want another hearing and proceed accordingly. The Veteran did not respond to the letter and the Board has proceeded with this appeal. This matter was previously remanded by the Board for further development in September 2019 and September 2020. The case has now been returned to the Board for appellate review. While the Board regrets the additional delay, remand is necessary for further development. Entitlement to service connection for a low back disability, to include as secondary to service-connected left leg disabilities The Veteran asserts that his low back disability began during service, or alternatively, is due to or aggravated by his service-connected left leg and foot disabilities. Specifically, during the May 2019 Board hearing, the Veteran testified that he sustained left leg and foot injuries during service that caused an altered gait, which caused his low back pain. He stated that he first noticed the low back pain in approximately 1980, one year prior to his separation from service. He stated that he mentioned the low back pain to a captain but did not seek further treatment at that time because he was already exempt from running due to his left knee injury. He explained that his low back pain has continued since that time. Post-service VA treatment records indicate complaints of low back pain as early as March 2001. The Veteran was previously seen for a VA examination to determine the etiology of his back disability in October 2012. That examiner opined that the Veteran’s lumbar spine degenerative joint disease was “less likely as not (50 percent or lesser probability) proximately due to or the result of service-connected left knee, foot, and thigh conditions.” The examiner stated that there was a lack of any body of scientific knowledge suggesting that his left knee, foot, or thigh conditions can cause or aggravate his lumbar spine condition. No opinion was provided addressing direct service connection. In its September 2020 remand, the Board found that an addendum opinion was necessary for clarification and application of the correct legal standard. Pursuant to the September 2020 remand, an addendum opinion was obtained in October 2020. The clinician opined that the Veteran’s current low back disability is less likely than not related to service because the Veteran’s service treatment records (STRs) are silent as to complaints for back pain and his altered gait is due to foot pathology, not back pathology. Further, he opined that the Veteran’s low back disability is less likely than not proximately due to or aggravated by his service-connected left leg and/or foot disabilities. As rationale, he stated that there is no scientific evidence that those disabilities cause low back arthritis, and those disabilities themselves are the cause of the Veteran’s antalgic gait. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). A bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 18, 22 (2007). The Board finds the October 2012 VA examination and October 2020 addendum opinions to be inadequate for rating purposes as the examiner's rationale for the requested opinions is lacking full medical explanations. Specifically, the examiner’s rationale does not address any of the Veteran’s lay reports regarding the onset and continuity of symptomatology. The Board notes that the lack of documented complaints or an in-service diagnosis, standing alone, is not an adequate basis for a negative opinion. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Further, the examiner noted that the Veteran’s antalgic gait was due to his service-connected left leg and foot disabilities but failed to address whether the altered gait could have caused his current low back disability as specifically requested in the September 2020 Board Remand. Due to these deficiencies, as well as the lack of rationale or discussion of the Veteran's lay statements regarding the onset of symptomatology during service, the Board finds the October 2012 VA examination and accompanying addendum opinions to be inadequate for rating purposes. Therefore, an addendum opinion addressing these deficiencies is warranted. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from a clinician of appropriate expertise to determine the nature and etiology of the Veteran’s low back disability. The examiner is to be provided access to the Veteran's electronic claims file and must specify in the report that these records have been reviewed. (a) After the review of the electronic claims file and examination of the Veteran, the examiner should identify and state all low back disabilities found. An explanation for any opinions expressed must be provided, and if the requested information cannot be provided without resort to speculation, the examiner should so state and explain why. (b) The examiner should then opine whether the Veteran's identified disabilitie(s) at least as likely as not (50 percent or greater probability) began in or are otherwise the result of military service. (c) If not directly related to service, the examiner should offer an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that any low back disability is caused by his service-connected disabilities. (d) That examiner should then opine whether the low back disability is aggravated (i.e., permanently worsened beyond the normal progression of that disease) by any of his service-connected disabilities. A specific discussion of any gait problems and whether any such gait problem caused or aggravated the Veteran's low back disability should be set out. The examiner should specifically address the Veteran’s lay statements regarding the onset and continuity of symptomatology since service. The examiner is advised that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should explain why. The examiner must provide a complete rationale for any opinions expressed, based on the examiner's clinical experience, medical expertise, and established medical principles. If an opinion cannot be made without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. If it is determined that another VA examination is required in order to provide the requested opinions, such examination should be arranged. The examiner is advised that the fact that the Veteran’s STRs are silent as to complaints of back pain alone, is not sufficient rationale for a negative etiological opinion. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Sneeringer, 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.