Citation Nr: 21015149 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 14-07 124 DATE: March 16, 2021 REMANDED Entitlement to service connection for a lumbar spine disorder, to include as secondary to service-connected bilateral knee disabilities, is remanded. Entitlement to service connection for a cervical spine disorder, claimed as secondary to a lumbar spine disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1980 to October 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in August 2012 by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In May 2016, August 2018, and August 2020, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to service connection for a lumbar spine disorder, to include as secondary to service-connected bilateral knee disabilities. In the August 2020 remand, the Board observed that an October 2019 VA examiner opined that the Veteran’s lumbar spine disorder is less likely than not proximately due to, the result of, or aggravated by his service-connected bilateral knee disabilities. In support thereof, he reasoned that the mechanism by which a right and left knee condition might aggravate a back condition is by significantly altered biomechanics resulting from a significantly altered gait over a significant period of time. The examiner noted that the Veteran had an altered gait reported as “limp” or “antalgic gait” but relied on the fact that no severity was reported on multiple occasions since 2010 and his altered gait was never noted to be due to his knee conditions. However, as he did not address the Veteran’s report that his bilateral knee disabilities prohibited him from properly lifting heavy objects and, consequently, put undue stress on his back, which resulted in an abnormal gait, the Board remanded the case in order to obtain an addendum opinion that adequately considered such report. Thereafter, in November 2020, a VA examiner reviewed the record and again opined that the Veteran’s lumbar spine disorder was less likely than not proximately due to, the result of, or aggravated by his service-connected bilateral knee disabilities. In this regard, he noted that the mechanism by which a right or left knee condition might cause or aggravate a lumbar spine condition is by significantly altered biomechanics resulting from a significantly altered gait resulting from a right or left knee condition over a significant period of time. However, the examiner found that the Veteran had no documented or reported history of same over a significant period of time. In regard to the Veteran’s report that his bilateral knee disabilities prohibited him from properly lifting heavy objects and, consequently, put undue stress on his back, which resulted in an abnormal gait, the examiner stated that improper lifting would likely result in strain rather than the Veteran’s current lumbar spine disorders and to state otherwise would be mere speculation. However, it does not appear that the November 2020 VA examiner considered all relevant facts in regard to whether the Veteran’s bilateral knee disabilities resulted in an altered gait which, in turn, affected his back. In this regard, as noted by the October 2019 VA examiner, the Veteran had an altered gait reported as “limp” or “antalgic gait” since 2010. Furthermore, in her February 2021 Written Brief Presentation, the Veteran’s representative cited to medical articles discussing how an injury to one part of the body can lead to injury or dysfunction in another part of the body. Specifically, it was noted that impairments in knee strength, stability, or flexibility can predispose the back to injury due to the chain reaction of forces moving through the lower extremities. Thus, a remand is necessary in order to obtain an addendum that addresses such matters. 2. Entitlement to service connection for cervical spine disorder, claimed as secondary to a lumbar spine disorder. In the August 2020 remand, the Board observed that an October 2019 VA examiner opined that the Veteran’s cervical spine disorder is less likely than not proximately due to, the result of, or aggravated by his service-connected lumbar spine disorder. However, as he provided an inadequate rationale in that he only stated that the Veteran’s currently diagnosed cervical spine disorders were not known to be caused by his currently diagnosed lumbar spine disorders and were instead likely related to a post-service motor vehicle accident without explaining why and did not address the Veteran’s report that his neck problems started after his back surgery in 2011 as requested in the August 2018 remand, the Board remanded the case in order to obtain an addendum opinion that addressed such matters. Thereafter, in November 2020, a VA examiner reviewed the record and again opined that the Veteran’s cervical spine disorder was less likely than not proximately due to, the result of, or aggravated by his service-connected lumbar spine disorder. In this regard, he noted that the mechanism by which a lumbar spine disorder might cause or aggravate a cervical spine disorder is by significantly altered biomechanics resulting from a significantly altered alignment of the lumbar spine over a significant period of time. However, the examiner found that the Veteran had no documented or reported history of same over a significant period of time. However, the examiner did not consider or discuss the Veteran’s report that his neck problems started after his back surgery in 2011 as requested by in the August 2020 remand. Furthermore, in her February 2021 Written Brief Presentation, the Veteran’s representative cited to a medical article discussing the percentage of patients who complain of low back pain also complain of neck pain. Thus, a remand is necessary in order to obtain an addendum that addresses such matters. The matters are REMANDED for the following action: Return the record, to include a copy of this Remand, to the VA examiner who offered the November 2020 opinion addressing the etiology of the Veteran’s lumbar and cervical spine disorders. If he is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. Following a full review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s lumbar spine disorder, currently diagnosed as degenerative disc disease of the lumbar spine and lumbar herniated disc status-post fusion, is caused by or aggravated by his service-connected bilateral knee disabilities, to include as a result of an altered gait? For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified, if possible, or aggravation beyond the baseline symptomatology. In offering such opinion, the examiner must consider and discuss the act the Veteran had an altered gait reported as “limp” or “antalgic gait” since 2010, and the medical articles cited by his representative in her February 2021 Written Brief Presentation that discuss the theory that impairments in knee strength, stability, or flexibility can predispose the back to injury due to the chain reaction of forces moving through the lower extremities. (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s cervical spine disorder, currently diagnosed as degenerative arthritis and spondylolisthesis of the cervical spine, is caused or aggravated by his lumbar spine disorder? For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner must consider and discuss the Veteran’s testimony that his neck problems did not start until after his back surgery in 2011 and the medical articles cited by his representative in her February 2021 Written Brief Presentation that discuss the percentage of patients who complain of low back pain also complain of neck pain. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Waite 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.