Citation Nr: 21024068 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-09 044 DATE: April 22, 2021 REMANDED Entitlement to service connection for a lumbar spine disorder, claimed as low back strain, is remanded. REASONS FOR REMAND The Veteran had active duty from September 1986 to March 1987 and from October 2001 to September 2002. The Veteran also had additional service in the Reserves. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in November 2018, when it was remanded for further development. 1. Lumbar Spine Disorder The Veteran asserts that he experiences a lumbar spine disorder which is related to his active service. Specifically, the Veteran asserts that his low back pain first began during field artillery training and secondly in 2014 during annual field training. In its November 2018 remand, the Board directed the agency of original jurisdiction (AOJ) to request through official sources verification of the Veteran's active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) in 2012, 2013 and 2014. The Board also directed an examiner to opine as to the etiology of the Veteran’s lumbar spine disorder. Specifically, the examiner was to opine as to whether it was at least as likely as not that the condition was incurred in or is otherwise related to a period of active duty, ACDUTRA and/or INACDUTRA. The examiner was asked to address the Veteran’s reserve service treatment records dated between 2013 and 2014 pertaining to complaints of or treatment for the low back and the Veteran’s contentions that his low back pain first began during field artillery training and secondly in 2014 during annual field training. See Board remand, November 16, 2018. The Veteran underwent a back examination in January 2020, with an addendum opinion in December 2020. See Back Conditions Disability Benefits Questionnaire (DBQ), January 23, 2020; Back Conditions DBQ, December 30, 2020. Unfortunately, there has not been compliance with the Board’s remand directives and has not obtained the requisite information. The January 2020 and the December 2020 VA examiners did not address the questions asked by the Board in its November 2018 remand directions. Specifically, the examiner did not address the Veteran’s reserve service treatment records dated between 2013 and 2014 pertaining to complaints of or treatment for the low back, or the Veteran’s contentions that his low back pain first began during field artillery training and secondly in 2014 during annual field training. Compliance with a Board remand directive is neither optional nor discretionary. See Stegall v. West, 11 Vet. App. 268 (1998). As such, another addendum opinion should be obtained on remand. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, return the claims file to the January 2020 and/or the December 2020 examiner for an addendum opinion, if available. A complete and detailed rationale should be given for all opinions and conclusions expressed. The need for further in-person examination is left to the discretion of the examiner. The examiner should once again review the claims file and provide an addendum opinion clarifying the following: For every diagnosed back disorder, is it at least as likely as not (50 percent or greater probability) that the disorder was incurred in, or is otherwise related to, a period of active duty, ACDUTRA and/or INACDUTRA? The examiner must address the reserve service treatment records dated between 2013 and 2014 pertaining to complaints of or treatment for the low back. The examiner must also address the Veteran’s contentions that his low back pain first began during field artillery training and secondly in 2014 during annual field training. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lech, 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.