Citation Nr: 21022062 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 14-06 916 DATE: April 14, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for a right wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1961 to December 1962 and from August 1969 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran testified before the undersigned Veterans Law Judge. The Board remanded the appeal for further development in June 2015. In May 2018, the Board requested a Veterans Health Administration (VHA) expert medical opinion. In September2018, the Board provided him a copy of the opinion and informed him of his right to submit any additional evidence within 60 days of the notification letter. The Veteran responded indicating he had no further argument or evidence to submit; therefore, the Board remanded the appeal for further development in December 2018. The Board regrets additional delay but, unfortunately, another remand is required. Pursuant to the Board’s December 2018 remand directives, addendum opinions were obtained in October 2019 and February 2021. The Board asked the examiner to opine on the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s low back disability had its onset in or is otherwise related to his period of service from October 1961 to December 1962? In addressing this question, the examiner was asked to please consider the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty and support your conclusion with rationale. (b) If the answer to question (a) is no, is there is clear and unmistakable (obvious, manifest, and undebatable) evidence that a low back disability preexisted the Veteran’s second period of service beginning in August 1969? In addressing this question, the examiner was asked to please discuss the Veteran’s STRs and his competent and credible lay statements and testimony regarding twisting and straining of the low back during his first period of active duty, as well as the January 1969 motorcycle accident and support your conclusion with rationale. (c) If the answer to question (b) is yes, is there clear and unmistakable (obvious, manifest, and undebatable) evidence that the pre-existing low back disability did NOT increase in severity during his second period of active duty from August 1969 to January 1970? In addressing this question, the examiner was asked to please discuss the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty and the September 1969 injury and support your conclusion with rationale. (e) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral knee disability: (i) had its onset in or is otherwise related to either period of service; (ii) is proximately due to the low back disability; or (iii) has been aggravated (worsened) by the low back disability? The examiner must note the Veteran’s competent and credible lay statements regarding the injuries he sustained to the knees when he braced himself from falling while working in a wet and slippery kitchen during service and the current injuries he sustains to his knees as a result of falling when his back gives way. (f) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s right wrist disability: (i) had its onset in or is otherwise related to either period of service; (ii)is proximately due to the low back disability; or (iii) has been aggravated (worsened) by the low back disability? The examiner must note the Veteran’s competent and credible lay statements regarding the injuries he sustained to his right wrist when he braced himself from falling while working in a wet and slippery kitchen during service and the current injuries he sustains to his right wrist as a result of falling when his back gives way. Here, both examiners’ opinions are inadequate, as they did not address: the Veteran’s lay statements regarding twisting and straining of the low back during kitchen duty; whether there is clear and unmistakable (obvious, manifest, and undebatable) evidence that the pre-existing low back disability did NOT increase in severity during his second period of active duty from August 1969 to January 1970; the Veteran’s lay statements regarding the injuries he sustained to the knees when he braced himself from falling while working in a wet and slippery kitchen during service and the current injuries he sustained to his knees as a result of falling when his back gives way; and his lay statements regarding the injuries he sustained to his right wrist when he braced himself from falling while working in a wet and slippery kitchen during service and the current injuries he sustains to his right wrist as a result of falling when his back gives way, as specifically requested by the Board. Thus, for these reasons, an addendum opinion is needed on remand to ensure substantial compliance with the Board’s December 2018 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Obtain an addendum opinion from a VA examiner other than the October 2019 and February 2021 VA examiners, preferably a physician, to determine the etiology of the Veteran’s back, bilateral knee, and right wrist disabilities. The claims file, to include a copy of this remand, must be made available to the examiner for review. No additional examination of the Veteran is necessary unless the examiner determines otherwise. Following a review of the claims file, the examiner should address the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s low back disability had its onset in or is otherwise related to his period of service from October 1961 to December 1962? In addressing this question, please accept as true the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty and provide a discussion on whether a nexus relationship is medically plausible given his above reports. Otherwise, the opinion will be inadequate. (b) If the answer to question (a) is no, is there is clear and unmistakable (obvious, manifest, and undebatable) evidence that a low back disability preexisted the Veteran’s second period of service beginning in August 1969? In addressing this question, please discuss the Veteran’s service treatment records (STRs) and accept as true his competent and credible lay statements and testimony regarding twisting and straining of the low back during his first period of active duty, as well as the January 1969 motorcycle accident. (c) If the answer to question (b) is yes, is there clear and unmistakable (obvious, manifest, and undebatable) evidence that the pre-existing low back disability was NOT aggravated (worsened beyond natural progression) during his second period of active duty from August 1969 to January 1970? In addressing this question, please discuss and accept as true the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty and the September 1969 injury. (d) If the answer to question (b) is no, or the answer to question (b) is yes and the answer to question (c) is no, is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s back disability had its onset in or is otherwise related to his period of service from August 1969 to January 1970? In addressing this question, please accept as true and consider the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty and the September 1969 injury. (e) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral knee disability: (i) had its onset in or is otherwise related to either period of service; (ii) is proximately due to the low back disability, if service-connected above; or (iii) has been aggravated (worsened) by the low back disability, if service-connected above? The examiner should accept as true and note the Veteran’s competent and credible lay statements regarding the injuries he sustained to the knees when he braced himself from falling while working in a wet and slippery kitchen during service and provide a discussion on whether a nexus relationship is medically plausible given his above reports. The examiner must also note the current injuries he sustains to his knees as a result of falling when his back gives way. (f) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s right wrist disability: (i) had its onset in or is otherwise related to either period of service; (ii) is proximately due to the low back disability, if service-connected above; or (iii) has been aggravated (worsened) by the low back disability, if service-connected above? The examiner should accept as true and note the Veteran’s competent and credible lay statements regarding the injuries he sustained to his right wrist when he braced himself from falling while working in a wet and slippery kitchen during service and provide a discussion on whether a nexus relationship is medically plausible given his above reports. The examiner must also note the current injuries he sustains to his right wrist as a result of falling when his back gives way. The examiner is advised that inquiries (e)(ii), (e)(iii), (f)(ii) and (f)(iii) require separate opinions for proximate causation and aggravation and a comprehensive rationale must be furnished for all opinions expressed. The examiner is also advised that a low back disability need not be service-connected or even diagnosed at the time a bilateral knee or right wrist disability is incurred and reliance on this fact will render the opinion inadequate. A comprehensive rationale must be furnished for all opinions expressed. If the examiner is unable to provide a medical opinion, then he or she should provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Asante, Ruby 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.