Citation Nr: 21021599 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 18-47 024 DATE: April 13, 2021 REMANDED Entitlement to service connection for a lumbar spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty from May 2003 to October 2003; from May 2007 to October 2007; from July 2008 to October 2008; and from January 2010 to April 2010. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision. The Board remanded the matter in June 2020 for a new VA examination. Entitlement to service connection for a lumbar spine disability. The June 2020 VA examiner opined that the Veteran’s lumbar spine disability clearly and unmistakably existed prior to service and was not aggravated beyond its natural progression by an in-service event, injury, or illness. The rationale for the opinion was that the examiner could not locate any evidence of the Veteran’s reported 2008 in-service injury, where he slipped off a ladder and fell, which worsened his condition, and therefore had no evidence of in-service aggravation. Review of the record shows a February 10, 2008 service treatment note stating the Veteran “missed the footing on the bottom step of the boarding ladder and felt a twinge in his back. This was over a UTA.” As there is evidence in the Veteran’s service treatment records of his 2008 fall that was unreviewed by the clinician, the examiner failed to review pertinent medical history and the opinion is inadequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). A remand for a new VA examination is warranted. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the Veteran’s lumbar spine disability. A new examination is only required if deemed necessary by the examiner. (a.) The examiner should opine whether there is clear and unmistakable evidence (obvious or manifest) that lumbar spine disability pre-existed any of his periods of service. (b.) If there is clear and unmistakable evidence that lumbar spine disability per-existed a period of service, the clinician is asked to opine as to whether there is clear and unmistakable evidence that the pre-existing disorder did NOT undergo an increase in the underlying pathology during service. The clinician is asked to specifically address the Veteran’s slipping from a ladder in February 2008, as documented by service treatment records. If there was an increase in the severity of lumbar spine disability, the examiner should offer an opinion as to whether such increase was clearly and unmistakably due to the natural progress of the disease. (c.) If there is no clear and unmistakable evidence that any current lumbar spine disability pre-existed a period of service, then the clinician is asked whether it is at least as likely as not that the disorder is directly related to an in-service injury, disease, or event. All opinions provided must be thoroughly explained, and a complete and detailed rational for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The clinician is reminded that the term “clear and unmistakable” means that reasonable minds could not differ, and that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Marissa Caylor Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Lee Feldman, 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.