Citation Nr: 21013689 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 06-36 663 DATE: March 10, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1975 to December 1978. This appeal comes to the Board of Veterans’ Appeals (Board) from a September 2006 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter in April 2013, June 2015, May 2016, and January 2020 for additional evidentiary development. In the January 2020 decision, the Board granted the Veteran entitlement to service connection for a lumbar spine disability to include as secondary to service-connected disabilities and remanded the issue of entitlement to service connection for a cervical spine disability to the Agency of Original Jurisdiction (AOJ). The Board instructed the AOJ to obtain a medical opinion on whether it is at least as likely as not that the Veteran’s lumbar spine disability caused or aggravated his cervical spine disability. While the AOJ obtained an opinion in March 2020, the Veteran’s representative contends that the opinion is adequate because it does not address the Veteran’s contentions about the basis for his claim. See January 2021 Appellant’s Post-Remand Brief. The examiner provided a negative nexus opinion indicating there is no evidence that the lumbar spine disability may cause or aggravate a cervical disability, but the examiner did not discuss the Veteran’s statements and supporting evidence regarding the claim of aggravation. In pertinent part, the examiner should consider the Veteran’s contention that his service-connected disabilities of the lumbar spine and knees caused changes in his biomechanics (e.g. changes in the way he walks and distributes weight), which places stress on his cervical spine. See, e.g., August 2015 letter from the Veteran; September 2008 letter from the Veteran. The examiner should also address pertinent medical literature on this subject including a 2011 article from Jacksonville Orthopaedic Institute in the claims file indicating that damage to the shock-absorbing discs of the lower back may affect the functioning of other parts of the musculoskeletal system. The Board has stressed the need for the examiner’s opinion to address the Veteran’s statements and cite the pertinent medical literature in its prior remand orders. On remand, the AOJ should obtain an additional medical opinion addressing these concerns before readjudicating the claim. The matters are REMANDED for the following action: 1. The AOJ should contact the Veteran and all current representatives and request their assistance in identifying any outstanding relevant records. The AOJ should make reasonable attempts to obtain all identified outstanding records and associate them with the Veteran’s claims file. The AOJ should also review the claims file and ensure that all documents with foreign language are translated into English. 2. After associating all outstanding records with the Veteran’s claims file, the AOJ should obtain an additional medical opinion addressing the etiology of the Veteran’s cervical spine disability. The AOJ should provide the examiner with a complete copy of the claims file to include this remand order. The AOJ should ensure that the examiner follows these directives: (a.) The VA examiner should identify all current disabilities associated with the Veteran’s cervical spine. (b.) For each current disability identified, the examiner should opine whether the disability at least as likely as not first manifested during or was otherwise caused by the Veteran’s military service. The examiner should explain why or why not with discussion of pertinent statements from the Veteran about the continuity of relevant symptoms from his time of service through the present. See, e.g.¸ March 2019 letter from the Veteran. (c.) In regard to diagnoses of arthritis, the examiner should opine whether the arthritis at least as likely as not manifested to a compensable degree (e.g. any functional limitation due to pain) within one year of the Veteran’s separation from active duty military service. (d.) For each current disability identified, the examiner should opine whether the disability was at least as likely as not caused by or worsened beyond normal progression (aggravated permanently or temporarily) by the Veteran’s service-connected disabilities to include his lumbar spine disability and knee disabilities. The examiner should consider the Veteran’s contention that his service-connected disabilities of the lumbar spine and knees caused changes in his biomechanics (e.g. changes in the way he walks and distributes weight), which places stress on his cervical spine. See, e.g., August 2015 letter from the Veteran; September 2008 letter from the Veteran. The examiner should also address pertinent medical literature on this subject including a 2011 article from Jacksonville Orthopaedic Institute indicating that damage to the shock-absorbing discs of the lower back may affect the functioning of other parts of the musculoskeletal system. (e.) If the examiner is unable to provide an opinion on these matters, the examiner must state whether the inability to render an opinion is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After completing the above action and any other necessary development, the claim must be readjudicated. If the claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and current representatives. After the Veteran has had adequate opportunity to respond, the appeal must be returned to the Board for appellate review. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael Duffy, 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.