Citation Nr: 21015867 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 09-49 338 DATE: March 18, 2021 ORDER Service connection for a back disability is granted. Service connection for vertigo is granted. REMANDED Service connection for a neck disability is remanded. Service connection for a skin condition, to include seborrheic dermatitis and eczema, is remanded. FINDINGS OF FACT 1. The Veteran’s back disability is at least as likely as not related to service. 2. The Veteran’s vertigo is at least as likely as not related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for a back disability are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for vertigo are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1987 to December 1987 and from November 1990 to September 1991 in the U.S. Army. This matter comes before the Board of Veterans’ Appeals (Board) from a February 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. This matter was most recently before the Board in June 2018 at which time the issues on appeal were remanded for further development. This case has now returned to the Board for appellate consideration. The Veteran testified before the undersigned Veterans Law Judge at Board hearings in August 2010 and December 2020. The hearing transcripts are associated with the record and have been considered. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Back Disability The Veteran contends that her back disability is related to service. The Veteran has current diagnoses of degenerative disc disease and spondylosis. Additionally, the Veteran competently and credibly testified that her back pain began during service when she had to carry heavy equipment and a rucksack. She also competently and credibly testified that she did not seek formal treatment for her back pain during service, but she took over the counter medication and used a heating pad. As such, the Veteran satisfies the first two elements of service connection. Regarding the third element, the Veteran was afforded a VA examination in November 2019. The examiner diagnosed the Veteran with spondylosis and left lower extremity radiculopathy. The examiner opined that the Veteran’s back disability, to include degenerative disc disease of the lumbar spine with spondylosis, left sciatica, and left radiculopathy, is less likely than not related to service because there is no evidence of a back injury in the Veteran’s service treatment records (STRs) and there is no relationship between her current back issues and her active duty service. The examiner further explained that carrying heavy bags in service may cause some back and neck sprain short term, but it cannot and should not cause degenerative arthritis or radiculopathy. In August 2019, the Veteran submitted an opinion from her physician. The physician opined that in his professional experience and knowledge of the medical literature, the Veteran’s low back pain and scoliosis are more likely than not caused by military service. The physician’s rationale stated that he is familiar with the Veteran’s medical history, has examined the Veteran, and she has no other risk factors that may have precipitated her current condition except for military service. The Board finds the evidence to be in relative equipoise as to whether the Veteran’s back disability is related to service. If the evidence is supportive or is in relative equipoise, then the veteran prevails. See 38 C.F.R. § 3.102. Accordingly, service connection for a back disability is granted. 38 C.F.R. § 3.303. Vertigo The Veteran contends that her vertigo is related to military service. The Veteran has a current diagnosis of benign paroxysmal positional vertigo. Additionally, during the December 2020 Board hearing, the Veteran competently and credibly testified that her vertigo and dizziness had its onset during active service while she was returning home from Desert Storm. As such, the Board finds that the first two elements of service connection are satisfied. Regarding the third element, the Veteran was afforded a VA opinion was obtained in November 2019. The examiner opined that the Veteran’s benign paroxysmal positional vertigo is less likely than not due to or caused by the vertigo disability during service because there is no evidence of vertigo in the Veteran’s STRs. In August 2019, the Veteran submitted an opinion from her physician. The physician opined that in his professional experience and knowledge of the medical literature, the Veteran’s benign paroxysmal positional vertigo is more likely than not caused by military service. The physician’s rationale stated that he is familiar with the Veteran’s medical history, has examined the Veteran, and she has no other risk factors that may have precipitated her current condition except for military service. The Board finds the evidence to be in relative equipoise as to whether the Veteran’s vertigo is related to service. If the evidence is supportive or is in relative equipoise, then the veteran prevails. See 38 C.F.R. § 3.102. Accordingly, service connection for benign paroxysmal positional vertigo is granted. 38 C.F.R. § 3.303. REASONS FOR REMAND Neck Disability The Veteran contends that her current neck disability is related to service. Alternatively, the Veteran contends that her neck disability is related to her service-connected posttraumatic stress disorder (PTSD) or fibromyalgia. The Veteran was afforded a VA examination in November 2019. The examiner diagnosed the Veteran with cervical strain and opined that the Veteran’s claimed neck disability is less likely than not related to service. The rationale stated that no nexus can be established because there is no specific incident in the Veteran’s STRs that could explain the current cervical strain. The Board finds the November 2019 VA opinion is inadequate for adjudication purposes because it is conclusory and does not adequately address the Veteran’s contentions. Additionally, no examiner has opined as to whether the Veteran’s neck disability is related to her service-connected PTSD or fibromyalgia. Accordingly, remand is warranted to obtain an addendum opinion. Skin Condition The Veteran contends that her skin condition, to include seborrheic dermatitis and eczema, is related to her service in the Gulf War. Alternatively, the Veteran contends that her skin condition is related to her service-connected PTSD or fibromyalgia. A VA opinion was obtained in November 2019. The physician opined that the etiology of the Veteran’s seborrheic dermatitis is unknown. The rationale stated that the Veteran’s STRs are absent for any skin condition complaints or visits while the Veteran was on active duty and her seborrheic dermatitis was diagnosed after she left service. The Board finds the November 2019 opinion is inadequate for adjudication purposes because it is conclusory and does not adequately address the Veteran’s contentions. The opinion also relies on the lack of documentation in the Veteran’s STRs. Additionally, no examiner has opined as to whether the Veteran’s skin condition is related to her service-connected PTSD or fibromyalgia. Accordingly, remand is warranted to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate physician to determine the nature and etiology of the Veteran’s claimed neck disability. If an examination is deemed necessary by the physician, then one should be scheduled, and all necessary tests and studies should be completed. Upon review of the claims file, the physician is asked to opine as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s neck disability had its onset in service. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s neck disability is related to any in-service injury, event, or disease. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s neck disability was (1) proximately due to or (2) aggravated by her service-connected posttraumatic stress disorder or fibromyalgia. A complete rationale must be provided for all opinions offered. If the physician cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case. Further, the physician must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community. The physician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that her reports must be considered in formulating the requested opinion. The physician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. 2. Obtain an addendum opinion to determine the nature and etiology of the Veteran’s claimed skin condition, to include seborrheic dermatitis and eczema. If an examination is deemed necessary by the physician, then one should be scheduled, and all necessary tests and studies should be completed. Upon review of the claims file, the physician is asked to opine as to the following for each diagnosis: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin condition had its onset during service. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin condition was otherwise incurred in or caused by any injury, event, or disease during active service, to include exposure to environmental hazards while serving in the Gulf War. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s skin condition was (1) proximately due to or (2) aggravated by the Veteran’s service-connected posttraumatic stress disorder or fibromyalgia. The physician should address the Veteran’s lay statements of record, including that she had dryness and scaling during service. A complete rationale must be provided for all opinions offered. If the physician cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case. Further, the physician must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community. The physician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that her reports must be considered in formulating the requested opinion. The physician is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Kernen, 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.