Citation Nr: 21021193 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 14-23 147 DATE: April 12, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1968 to December 1971. This case comes to the Board of Veterans’ Appeals (Board) on appeal of an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office. In November 2018, the Board denied the Veteran’s claims for entitlement to service connection for hypertension, gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), cervical spine disability, and thyroid cancer; and, it denied entitlement to an increased rating for service-connected skin cancer residuals, to include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and actinic keratosis. The Board remanded the issues of entitlement to an increased rating for posttraumatic stress disorder (PTSD) and for a total disability evaluation due to individual unemployability (TDIU). While on remand, the RO granted entitlement to a TDIU in an October 2019 rating decision. A separate January 2020 Board decision addressed the issue of entitlement to an increased rating for PTSD. The Veteran appealed the November 2018 Board decision to the Court of Appeals for Veterans Claims (Court), and in August 2020, the Court issued a Memorandum Decision Vacated the part of the November 2018 decision that denied service connection for a cervical spine disability, and remanded that issue for further proceedings. The Court affirmed those parts of the November 2018 Board decision that denied entitlement to service connection for hypertension, GERD, OSA, thyroid cancer, and entitlement to an increased rating for skin cancer residuals, to include BCC, SCC, and actinic keratosis. The Court’s August 2020 Memorandum Decision became final pursuant to a Mandate issued in November 2020. The Court’s August 2020 decision noted that the Veteran’s complete service treatment records could not be located. Where service records are destroyed or missing, VA has a heightened duty to assist a Veteran in developing his claim. O’Hare v. Derwinski, 1 Vet. App. 365 (1991). This duty includes a heightened obligation on the Board’s part to explain its findings and conclusions, and carefully consider the benefit of the doubt rule. Cromer v. Nicholson, 19 Vet. App. 215 (2005). The Board is still, however, required to determine whether the balance of the evidence is in favor of the claim before a claim can be granted. The Board finds that a remand is necessary to afford the Veteran a VA examination. MRI evidence of the Veteran’s neck shows multiple levels of stenosis. See September 2011 private treatment record. The record also includes findings of cervical radiculopathy. See September 2011 private treatment record. In his September 2019 Appellant’s Brief, the Veteran asserted that his neck disability was the result of repeated lifting of heavy equipment, to include ammunition and guns weighing 50 to 100 pounds, during his active service. He alternatively argued that his cervical spine disability is related to his service-connected skin cancer residuals, to include BCC, SCC, and actinic keratosis, and treatment related thereto. The Veteran has met the requirements under McLendon which would trigger VA’s duty to assist by affording the Veteran a VA examination. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); 38 U.S.C. § 5103A (d) (2); 38 C.F.R. § 3.159 (c) (4) (i). The Board, therefore, remands this issue so that the Veteran can be afforded an appropriate examination, and an opinion can be obtained addressing the nature and etiology of any current cervical spine disability.   The matter is REMANDED for the following action: Schedule the Veteran for an examination to address the nature and etiology of any current cervical spine disability. Following review of the claims file and examination of the Veteran, the examiner is asked to identify/diagnose any cervical spine disability that presently exists or has existed during the appeal period. The examiner must also specify whether the Veteran experiences neurological symptoms (radiculopathy) related to the cervical spine. For all diagnosed cervical spine disabilities, the examiner should provide the following opinions: (a) Whether it is at least as likely as not (50 percent or greater probability) that such disability onset in service or is/was otherwise etiologically related to service. The clinical significance of the Veteran’s report of repeatedly lifting heavy equipment to include ammunition and guns weighing 50 to 100 pounds during active service should be addressed. The Veteran’s report of experiencing neck pain in service should also be considered. (b) Whether it is at least likely as not (50 percent or greater probability) that such disability is proximately due to the service-connected skin cancer residuals, to include BCC, SCC, and actinic keratosis, to include the treatment and removal of any cancerous lesions. (c) Whether it is at least likely as not (50 percent or greater probability) that such disability underwent any incremental increased in disability, regardless of its permanence, due to the service-connected skin cancer residuals, to include BCC, SCC, and actinic keratosis, to include the treatment and removal of any cancerous lesions.. The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. (d) If arthritis is diagnosed, the examiner should state whether it is at least as likely as not (50 percent or greater probability) that arthritis manifested to a compensable degree within one year of separation from service. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must explain why. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Smith, 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.