Citation Nr: 21025058 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 14-05 413 DATE: April 27, 2021 REMANDED Entitlement to service connection for a low back disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from May 1984 to March 1988. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision. In January 2015, a video-conference was held before the undersigned; a transcript is in the record. In July 2015 the matter was remanded for additional development. Entitlement to service connection for a low back disability is remanded. The Board finds that there has not been substantial compliance with the previous remand directives, and that corrective action is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The July 2015 Board remand requested a medical opinion (with rationale) addressing whether the Veteran’s low back disability was (1) related to service to include as due to repetitive heavy lifting as part of his MOS, or (2) was caused or aggravated by his service-connected left foot disability. In an April 2017 medical opinion, the provider expressed inability to render an opinion whether the Veteran’s low back disability was related to service without resort to mere speculation. Additionally, the clinician did not address whether the Veteran’s service-connected left foot disability aggravated his low back disability via an altered gait. As the opinion provided failed to consider the Veteran’s lay statements and theory of entitlement, it is inadequate for rating purposes. When VA undertakes to obtain a medical opinion, it must obtain one that is adequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, development for another medical opinion which considers all evidence and all theories of entitlement raised or asserted, and provides adequate rationale for the opinion reached is necessary. The matter is REMANDED for the following: Arrange for the Veteran’s record to be forwarded to an appropriate clinician (in orthopedics, other than the provider of the April 2017 medical opinion), for review and a medical opinion regarding the nature and likely etiology of his low back disability. [If further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] On review of the record (to include the Veteran’s testimony at the January 2015 video-conference hearing), the clinician should respond to the following: (a.) Identify (by diagnosis) each low back disability shown by the record (or found on examination, if one is conducted). (b.) Identify the likely etiology for each low back disability shown. Is it at least as likely as not (a 50% of better probability) that the diagnosed entity was incurred in, or is directly related to, the Veteran’s service (and specifically as due to repetitive heavy lifting in his duties in his MOS, as alleged)? (c.) If a diagnosed low back disability is found to not be directly related to service, opine further whether disability at least as likely as not was caused or aggravated (the opinion must address aggravation, including the Veteran’s allegation that an altered gait from his service-connected left foot disability aggravates his low back disability) the disability. (d.) If a diagnosed low back disability is determined to not be related directly to service/heavy lifting therein, and to not have been caused or aggravated by the Veteran’s service-connected left foot disability, identify the etiology for the disability that is considered to be more likely, and explain why that is so. All opinions must include rationale that cites to supporting factual data and medical principles. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Staskowski, 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.