Citation Nr: 21016242 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 14-01 730 DATE: March 22, 2021 REMANDED The issue of service connection for a low back disability, to include as secondary to service-connected right and left knee disabilities, is remanded. The issue of a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1979 to November 1982. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2011 rating decision. In April 2016, the Veteran and his spouse testified at a Board hearing. Most recently, in March 2020, the Board remanded this matter for further evidentiary development. Pursuant to the March 2020 Board remand, a VA supplemental medical opinion was to be obtained regarding whether the Veteran’s service-connected right and left knee disabilities aggravated his low back disability. A VA supplemental opinion was obtained in April 2020. The examiner opined that the Veteran’s low back disability is not at least as likely as not proximately due to or the result of the Veteran’s service-connected disabilities. As rationale, the examiner stated, [The] Veteran is service connected for bilateral knee patellofemoral pain syndrome. There is no evidence in records review of any complaints of back pain during his active service which was from July 1979 to November 1982. [The] Veteran’s medical records [does not] support the claimed lumbar spondylosis and discogenic disease and it is less likely than not that this is due to the [V]eteran’s service connected conditions mentioned above as these are different disease entities with different anatomical, and biomechanical properties with different pathophysiological process unrelated to each other. The present lumbar finding is compatible with degenerative changes and is an expected change related to the normal process of aging. The examiner additionally opined it is less likely than not that the Veteran’s low back disability was aggravated beyond its natural progression by the Veteran’s service connected right and left knee disabilities. As rationale, the examiner stated, It is less likely than not that claimed condition was aggravated by service connected condition over time as there is no evidence of back pain during service or right after service. Evidence points to pain complaints appearing almost 30 years after his retirement from service. Most likely his back [condition] is more due to aging than progression or aggravation from service connected knee condition. As noted by the Veteran’s representative in the March 2021 Appellate Brief, although the April 2020 VA examiner stated that the Veteran’s low back disability was due to the normal aging process, he failed to explain why this was so. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Accordingly, a remand to obtain a new medical opinion is necessary. TDIU Because the claim of service connection for a low back disability is being remanded and may have a bearing on the Veteran’s employability, the TDIU claim is dependent, in part, on the outcome of the service connection claim for a low back disability and, therefore, is inextricably intertwined with that issue. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: Return the file to the April 2020 VA examiner for an addendum opinion. If that examiner is unavailable, the opinion should be provided by another examiner. If an examination is deemed necessary to answer the questions presented, one should be scheduled. The claims file must be reviewed by the examiner. Following review of the file, the examiner is to address the following: (a.) Is it at least as likely as not (50 percent probability or more) that the Veteran’s lumbar spondylosis and discogenic disease is, or has been, aggravated by service-connected right and left knee patellofemoral pain syndrome? (b.) If the examiner opines that the Veteran’s low back disability is due to the natural aging process, please explain why that is so. All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner’s consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability (Continued on next page) to provide an opinion is based on the limits of medical knowledge. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Griffith 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.