Citation Nr: 21025015 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 19-25 794 DATE: April 27, 2021 REMANDED Entitlement to service connection for low back condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1965 to June 1967. In July 2020, the Veteran testified at a Board hearing. The transcript is of record. Entitlement to service connection for low back condition is remanded. Once VA undertakes the effort to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In October 2018, the Veteran attended a VA examination for his low back condition. See October 2018 VA Examination. The examiner noted that the Veteran has a diagnosis of degenerative arthritis of the lumbar spine and lower extremity radiculopathy with intervertebral disc syndrome (IVDS). The Veteran reported suffering two hard landings that impacted his back. He jumped off an 8-foot airborne training platform and fell while lifting cement during service. The Veteran reported that both incidents resulted in back injury with soreness that continued after service. The Veteran also reported that when he was stationed in Vietnam, one of his jobs was handling and lifting heavy cement bags which he also contends contributed to his present low back conditions. The examiner opined that the Veteran's back conditions are less likely than not incurred in or caused by the claimed in-service injury, event, or illness as there was no significant service injury or trauma that would have likely predisposed the Veteran to his current multilevel arthritis. Further, the examiner opined that the Veteran’s symptoms have been worst recently which makes the relationship to service complaints in the 1960s unlikely. The examiner stated the Veteran’s low back conditions are likely age related without providing further explanation. The Board finds the opinion is insufficient for adjudication as it does not provide an adequate rationale. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). As the examiner failed to appropriately address and consider the Veteran's statements that his injury began during service and continued ever since and relied on the absence of evidence without explaining the significance of such, a remand is necessary to obtain an addendum medical opinion. Additionally, after the VA examination was completed the Veteran submitted articles regarding arthritis and the military that the Board finds should be reviewed addressed in rendering an opinion. See Correspondence. The matter is REMANDED for the following action: 1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran’s assertions. Neither the Veteran’s credibility nor any lack thereof should be presumed in this remand. 2. Obtain updated VA and/or pertinent private treatment records. If such records are unavailable, the Veteran's claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 3. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s low back pain was incurred in or cause by the claimed in-service injury, event or illness. In answering this question, discuss the STRs noting back problems during service, including but not limited to the August 1966, September 1966, and December 1966, medical notes, and discuss the Veteran’s lay assertions during the July 2020 Board hearing that his current low back problems are due to an in-service jump, fall, and heavy lifting. See December 2015 STR - Medical; see July 2020 Hearing Transcript. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. The examiner is to specifically address and reconcile, to the extent possible, this examination with the results of the October 2018 VA examination. The opinion should also address and reconcile with the findings, to the extent possible, the following scientific studies and articles submitted by the Veteran: a. Arthritis and the Military; Support Arthritis Research at the Department of Defense; b. Physical Demands of Army Military Occupational Specialties: Construction and Applying a Crosswalk to Evaluate the Relationship Between Occupational Physical Demands and Hospitalization; c. A Silent Enemy: How Arthritis is Threatening Veterans and the U.S. Military. A complete rational should be provided to support any provided opinions. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V. Schmidt 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.