Citation Nr: 21015904 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 10-18 788 DATE: March 18, 2021 REMANDED Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for residuals of traumatic brain injury (TBI), to include a headache disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to special monthly compensation (SMC) based on a need for aid and attendance and/or housebound status is remanded. Entitlement to special monthly pension (SMP) is remanded. Eligibility for financial assistance for automobile or other conveyance and adaptive equipment, or for adaptive equipment only, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1974 to June 1976. This appeal is before the Board of Veterans’ Appeals (Board) from an April 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office. In April 2017, the Veteran and his friend testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. The matters on appeal were remanded by the Board in September 2017, along with service connection claims for a bilateral knee disorder, bilateral ankle disorder, and lumbar spine disorder. In a July 2020 rating decision, the agency of original jurisdiction (AOJ) granted service connection for lumbosacral degenerative disc disease, right and left leg radiculopathy, right and left knee strain, and right and left ankle strain. In addition, entitlement to special monthly compensation based on housebound criteria being met was granted from January 15, 2013 to April 1, 2013 and from November 6, 2013 to January 9, 2014. The AOJ continued to deny the remaining matters on appeal, and they have been returned to the Board. In its September 2017 remand, regarding the service connection claims for cervical spine and TBI residual disability, the Board found previous February and March 2016 VA examiners’ opinions not to have fully considered the question of whether the Veteran’s service-connected bilateral foot disabilities—which he had reported resulted in an altered gait—had caused or aggravated his cervical spine or headache disorders, particularly in light of additional private treatment records showing emergency treatment for injuries to the neck, back, and head sustained from falls in 2006, 2011, and 2012. The Board therefore requested a new opinion addressing these matters. VA opinions dated in December 2017 and June 2020 from separate examiners were obtained. The December 2017 opinion related the Veteran’s headaches to his cervical spine condition (rather than TBI), and determined that his cervical spine condition was most likely a result of age progression wear and tear with a history of physical occupations. Regarding aggravation secondary to a service-connected condition, specifically falls from service-connected disability, both the December 2017 and June 2020 examiners found that the Veteran’s falls were due to nonservice-connected conditions. The December 2017 examiner noted that the Veteran had “multiple risk factors for falls including his history of [bilateral] lower extremity peripheral neuropathy with a potential cause of [alcohol] abuse or [alcohol] or Cocaine use as the veteran's medical records show multiple positive lab results of both [alcohol] and Cocaine use from 2006 through 2012.” The June 2020 examiner opined that the Veteran’s problems walking were the result of a spastic gait from his cervical spine disability and some cerebellar degeneration resulting in ataxia. However, while both examiners opined that the Veteran’s ambulation problems and falls were due to nonservice-connected, rather than service-connected, disabilities, the December 2017 examiner stated that there was no specific objective evidence that any of these falls were solely a result of his service connected conditions, and the June 2020 examiner opined that the Veteran’s ambulation difficulties were not “solely due to service connected disabilities of hammertoes, bilateral metatarsalgia and hallux valgus.” (Emphases added.) While the examiners provided explanation as to what other factors could have resulted in the Veteran’s falls and gait problems, the qualifier “solely” is not further explained by either examiner, and neither clarified whether any service-connected disability or disabilities could have been a partial cause of the Veteran’s falls. Furthermore, neither examiner considered the Veteran’s newly-service-connected disabilities in the July 2020 rating decision of lumbosacral degenerative disc disease, right and left leg radiculopathy, right and left knee strain, and right and left ankle strain; they only considered his previously service-connected feet disabilities of hammertoes, bilateral metatarsalgia, and hallux valgus. In this regard, the December 2017 examiner, addressing secondary service-connection for the Veteran’s claimed cervical spine disorder based on aggravation, in identifying the Veteran’s nonservice-connected risk factors for falls, specifically listed “[bilateral] lower extremity peripheral neuropathy.” Given the above, the service connection claims on appeal must again be remanded for an addendum clarifying the current VA opinions regarding secondary service connection for the Veteran’s claimed cervical spine disability. The addendum should: (1) consider all service-connected orthopedic disabilities, including the recently service-connected knee, ankle, lumbar spine, and radiculopathy disabilities; (2) clarify the term “solely” in the December 2017 and June 2020 opinions, and in doing so determine whether the Veteran’s falls were at least partially due to his service-connected disabilities; and (3) if so, determine whether any cervical spine disability was at least as likely as not aggravated by such falls. As noted in the Board’s September 2017 remand, the claim for service connection for a cervical spine disability may impact the outcome of the rest of the issues on appeal, and they are therefore inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The Board thus defers adjudication of the issues of service connection for residuals of TBI, to include a headache disorder, SMC, SMP, and eligibility for financial assistance for automobile or other conveyance and adaptive equipment, or for adaptive equipment only, until the matter of service connection for a cervical spine disability is adjudicated. The matters are REMANDED for the following action: 1. Obtain all outstanding pertinent VA medical records dated from December 2017 to the present. 2. Forward the claims file to a VA examiner to provide an addendum opinion to the December 2017 and June 2020 opinions. If the requested opinions cannot be provided without another examination of the Veteran, schedule him for a VA examination with an appropriate examiner. The claims file and a copy of this Remand must be reviewed by the examiner. After reviewing the claims file, to include the December 2017 and June 2020 VA opinions, the examiner should determine whether it is at least as likely as not (i.e. a 50 percent probability or more) that any cervical spine disability, to include degenerative disc disease, is caused or aggravated (i.e. worsened beyond its natural progression) by the Veteran’s service-connected disabilities, to include lumbosacral degenerative disc disease, right and left leg radiculopathy, right and left knee strain, right and left ankle strain, and bilateral foot disabilities of hammertoes, bilateral metatarsalgia and hallux valgus. The examiner is asked to consider the Veteran’s reports that he has an altered gait due to his service-connected disabilities that has resulted in falls, as well as to consider the private emergency treatment records that show the Veteran sustained injuries to his head, neck, and back from falls in 2006, 2011, and 2012. In so doing, the examiner should also: a) Note the December 2017 and June 2020 VA examiners’ statements that the Veteran’s falls were not “solely” due to his service-connected disabilities, and determine whether the Veteran’s falls were at least partially due to his service-connected disabilities; and b) If so, determine whether any cervical spine disability was at least as likely as not aggravated by such falls. (Continued on the next page)   All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, relevant medical treatises, and generally accepted medical principles is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Andrew Mack, 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.