Citation Nr: 21026518 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 14-04 165 DATE: May 3, 2021 REMANDED Service connection for a thoracolumbar spine disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1989 to September 1992. The Veteran testified before a Veterans Law Judge at a Board hearing in August 2018. A complete transcript is of record. This appeal was most recently before the Board in July 2020. The July 2020 Board decision remanded the service connection claims for a thoracolumbar spine disorder and a bullet/shell fragment wound for further development. Specifically, the Board remanded the issues for new VA examinations because the September 2019 VA examiner who provided medical opinions regarding the service connection claims did not acknowledge or discuss the Veteran's assertions indicating that he injured his back and sustained fragment wounds during his active duty service and has experienced a continuity of symptomatology. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Veteran was afforded a VA examination for his fragment wound in November 2020 and the VA examiner provided a medical opinion, but it was unclear whether a nexus had been established. However, the VA examiner provided an addendum opinion about a week later, clearly stating that the shrapnel fragment of the right hip was at least as likely as not due to his active duty service. Following the positive nexus opinion, a January 2021 rating decision granted the Veteran service connection for right hip pain, s/p bullet/shell fragment wound, muscle group XIII shrapnel fragment, muscle group XVI shrapnel fragment, and muscle group XVII shrapnel fragment. The grant of service connection for a bullet/shell fragment wound is considered a full grant of benefits sought on appeal and the claim is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Service connection for a thoracolumbar spine disorder is remanded. The Veteran was afforded a VA examination for his low back disorder in November 2020. The examiner was asked to provide an etiology opinion regarding direct service connection. The examiner was asked to discuss the assertions that the Veteran fell off of a tank and landed on his back during his active duty service and to discuss an August 2011 VA examination report which provided a positive nexus opinion. The VA examiner acknowledged in the Veteran's medical history that he was reported to have fell off of a tank in 1991 and acknowledged the August 2011 medical opinion; however, the VA examiner nonetheless provided a negative nexus opinion. The examiner explained that the Veteran indicated that he had back pain in 1991, during his active duty service, but on a periodic in-service examination in August 1992, he denied any underlying back pain. The examiner opined that the Veteran's 1991 back pain/injury resolved one year later, prior to his separation from the military. Here, the Board finds that the November 2020 VA examiner has provided an adequate medical opinion because they addressed the July 2020 Board remand directives and provided a rationale to support their opinion. As such, the Board finds that there has been substantial compliance with the July 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). However, since the July 2020 Board remand, the Veteran was awarded service connection for right hip shrapnel wounds and right hip pain in a January 2021 rating decision. VA received correspondence from the Veteran's representative in March 2021, stating that his back condition may be related to his service-connected right hip disability. The representative also stated that, the record on the whole makes it clear that his hip, back are interrelated and are therefore secondarily service connected based on his right hip; and that the shrapnel injury impacted both the hips and the low back. The Board has reviewed the Veteran's post-service medical records and observes that the Veteran's consistently complained of both right hip pain and low back pain and their complaints were usually in conjunction with one another. However, the Board finds that although the right hip and back pain were often complained about together, does not mean that they are necessarily related. The Board regrets that another remand will further delay a decision in this case, but finds that another VA examination is necessary so that an etiology opinion regarding secondary service connection can be obtained. Accordingly, service connection for a thoracolumbar spine disorder is remanded. The matters are REMANDED for the following action: 1. Schedule a VA examination to determine the etiology of any thoracolumbar spine disorder. The examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's shrapnel injury, which he is service-connected for in his right hip, caused his low back disability. Why or why not? (b) Is it at least as likely as not (50 percent or greater probability) that the thoracolumbar spine disorder is proximately due to or caused by the service-connected right hip disability? Why or why not? In so doing the examiner should review the medical evidence and argument submitted by the Veteran's representative (see Medical Treatment Record - Government Facility received 3/25/21) (c) Is it at least as likely as not (50 percent or greater probability) that the thoracolumbar spine disorder has been aggravated (made worse) by the service-connected right hip disability? Why or why not? If aggravation is found, the examiner should identify a baseline level of severity of the thoracolumbar spine disorder by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the thoracolumbar spine disorder. If such cannot be done, it should be explained why. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fu, 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.