Citation Nr: 21025885 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 14-34 900 DATE: April 29, 2021 REMANDED Entitlement to service connection for degenerative joint disease of the low back is remanded. Entitlement to service connection for neuropathy of the left leg (also claimed as nerve damage, left leg) as secondary to degenerative joint disease of the low back is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army for 20 total years to include from October 1972 to October 1974, from January 1976 to January 1979, and from March 1990 to May 2005. This appeal comes before the Board of Veterans’ Appeals (Board) from an August 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. These matters have previously come before the Board. In a November 2019 Memorandum Decision, the United States Court of Appeals for Veterans Claims (Court) vacated a May 2018 Board decision denying the instant claims. In May 2020 and October 2020, the Board remanded for additional medical opinions consistent with the Court’s opinion. Specifically, the Board instructed that an orthopedic surgeon should address whether the Veteran’s lower back degeneration was the result of wear and tear over a 20-year military career, and whether the degenerative process likely began within one year of the Veteran’s discharge in May 2005. The RO has obtained such medical opinions from two orthopedic surgeons, which together are in accordance with the Board’s instructions. Thus, the Board finds that its remand instructions were substantially complied with. Stegall v. West, 11 Vet. App. 268 (1998). Although further delay is regrettable, additional development is necessary before the Board may reach a decision in these matters. 1. Entitlement to service connection for degenerative joint disease of the low back is remanded. Arguing before the Court, the Veteran asserted that in October 2011, he sought treatment for back pain “caused by his service-connected knee disability.” See Brief for Appellant, within 4/08/2020 CAVC Decision file, at 22-23. A preliminary review of the medical record indicates that in late 2011, the Veteran sought treatment numerous times for both lower back pain and knee pain. The Board finds that the theory of secondary service connection is reasonably raised by the claimant and by the record, and thus the Board is required to consider and address such contention. See Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1355 (Fed. Cir. 2009). Service connection may be established on a secondary basis for a disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). As a part of the duty to assist claimants, VA must provide a medical examination or obtain a medical opinion when such an examination or opinion is necessary to make a decision on the claim. Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007); 38 U.S.C. § 5103A(d)(1). Although the Veteran has undergone several VA examinations for his lower back claim, no medical opinion has addressed whether the Veteran’s lower back degenerative condition has been caused or aggravated by his service-connected left knee patellofemoral pain syndrome. Further development is therefore necessary. 2. Entitlement to service connection for neuropathy of the left leg (also claimed as nerve damage, left leg) as secondary to degenerative joint disease of the low back is remanded. With respect to the Veteran’s claim for left leg sciatic neuropathy, the Board finds that this claim is inextricably intertwined with his pending service connection claim for lower back degenerative joint disease. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a significant impact upon another, the two claims are inextricably intertwined). These matters are REMANDED for the following actions: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. After completing #1, then obtain an addendum opinion to address secondary service connection of the Veteran’s lower back degenerative joint disease. After a review of the claims file, the reviewing clinician is to address: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s lower back degenerative joint disease is (1) proximately due to OR (2) aggravated beyond its natural progression by a service-connected disability, to include but not limited to his service-connected knee disabilities. (b.) If aggravation is found, please state, to the extent possible, the baseline level of disability prior to aggravation. The examiner’s attention is invited to private records of treatment in September to November 2011, for concurrent knee and lower back pain. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Hermsdorfer, 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.