Citation Nr: 21026807 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 12-26 170 DATE: May 4, 2021 REMANDED The issue of entitlement to service connection for a low back disorder is remanded. The issue of entitlement to service connection for a bilateral leg disorder, to include as secondary to a low back disorder, is remanded. The issue of entitlement to service connection for a groin disorder, claimed as secondary to a low back disorder, is remanded. The issue of entitlement to service connection for migraine headaches is remanded. The issue of entitlement to service connection for dizzy spells, vertigo, and/or Meniere's syndrome, to include as secondary to migraine headaches, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1983 to December 1986. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The procedural history of this case has been set forth in detail in the prior actions in the appeal. Accordingly, the procedural history will only be repeated herein as necessary to explain the state of the issues currently before the Board. Most recently, in March 2019, the Board remanded the matters for further development, to include obtaining addendum medical opinions regarding the etiology of the Veteran's claimed low back disability, dizzy spells, and migraine headaches; the claims for service connection for a bilateral leg disorder and a groin disorder were remanded as inextricably intertwined with the low back claim. Upon review of the development conducted on remand, the Board finds that additional remand of this matter is warranted, even though such will, regrettably, further delay an appellate decision on this matter. Specifically, the March 2019 remand directives instructed that the agency of original jurisdiction (AOJ) obtain a nexus opinion regarding the etiology of the Veteran's low back disorder. The directives stated that the examiner MUST (emphasis added) specifically address the following: 1) May 2017 buddy statements from the Veteran's older sister and spouse describing back symptoms extending back to service; 2) October 1991VA treatment records documenting radiographs of the lumbar spine being taken and a diagnosis of a low back strain; and 3) July 2001 VA treatment records. An addendum medical opinion was obtained in December 2019; unfortunately, the opinion provided was inadequate because it failed to address the listed evidence as required by the remand. The RO attempted to remedy this inadequacy by requesting an additional opinion to specifically addressed the listed evidence. The opinion provided, in September 2020, failed to provide an adequate rationale, stating only that the "[r]ecords reviewed are found to be credible." The lack of an adequate medical opinion in this case makes it impossible for the Board to make an informed determination as to whether service connection is warranted. Additionally, the opinion obtained fails to comply with the terms of the Board's prior remand. Accordingly, another remand is required to obtain an adequate medical opinion. addendum opinion is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand). Additionally, because the Veteran's claimed bilateral leg and groin disabilities are claimed to be secondarily related to the back disorder, adjudication of these claims should be deferred while the back claim is on remand. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). Regarding the Veteran's claimed migraine headache disorder and dizzy spells, in its March 2019 remand action, the Board noted that it was indicated that the Veteran did not suffer from migraines, but that he had been diagnosed with Meniere's disease and that the record raised a question as to whether the Veteran's Meniere's disease, vertigo, or disability manifested by dizzy spells was caused or aggravated by his headache disorder. The Board also noted that the record showed treatment for headaches, but that the examiner failed to address the Veteran's competent statements regarding chronic headaches. Notably, the March 2019 remand directives instructed that the AOJ obtain nexus opinions regarding direct and secondary service connection. The directives stated that the examiner MUST (emphasis added) specifically address the following: 1) VA treatment records from May 1987, less than 6 months after the Veteran's separation from service, for dizzy spells and a diagnosis of possible vertigo; 2) VA treatment records from April 2000 for dizzy spells accompanied by headaches; and 3) buddy statements from the Veteran's older sister and his spouse describing symptoms of dizziness after he returned home from active duty service. The medical opinions were provided in December 2019; unfortunately, the opinions provided are inadequate because they failed to address the listed evidence as required by the Board's March 2019 remand. The AOJ attempted to remedy this inadequacy by requesting an additional opinion to specifically address the listed evidence. The opinion provided, in September 2020, however, failed to provide an adequate rationale, stating only that the "[r]ecords reviewed are found to be credible." Additionally, a September 2020 opinion regarding service connection for vertigo, dizziness and Meniere's syndrome as secondary to headaches is also inadequate because it addressed causation, but failed to address aggravation. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (holding that secondary service connection is a two-part issue that involves analysis of causation and analysis of aggravation); 38 C.F.R. § 3.310. Accordingly, another remand is required to obtain adequate medical opinions. See Barr and Stegall, both supra. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician to determine the etiology of the Veteran's low back disorder. The examiner must review the claims file, and a copy of this Remand. Following a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) the Veteran's low back disability had its clinical onset during active service, manifested within one year of service, or is otherwise related to any in service disease, event, or injury. The examiner must specifically address the following: 1) May 2017 buddy statements from the Veteran's older sister and spouse describing back symptoms extending back to service; 2) October 1991 VA treatment records from October 1991 documenting radiographs of the lumbar spine being taken and a diagnosis of a low back strain; and 3) July 2001 VA treatment records. A complete rationale must be provided for all opinions. 2. Obtain an addendum opinion from an appropriate clinician to determine the etiology of the Veteran's headache disability. The examiner must review the claims file, and a copy of this Remand. Following a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) the Veteran's headache disability: a) had its clinical onset during active service, manifested within one year of service, or is otherwise related to any in service disease, event, or injury, to include the Veteran's documented in-service motor vehicle accident or other relevant trauma experienced by the Veteran in-service; b) is proximately due to the Veteran's dizzy spells, vertigo or Meniere's syndrome; c) is aggravated beyond its natural progression by the Veteran's dizzy spells, vertigo or Meniere's syndrome. The examiner must specifically address the following: 1) VA treatment records from May 1987, less than 6 months after the Veteran's separation from service, for dizzy spells and a diagnosis of possible vertigo; 2) VA treatment records from April 2000 for dizzy spells accompanied by headaches; and 3) buddy statements from the Veteran's older sister and his spouse describing symptoms of dizziness after he returned home from active duty service. A complete rationale must be provided for all opinions. 3. Obtain an addendum opinion from an appropriate clinician to determine the etiology of the Veteran's dizzy spells, vertigo, and Meniere's syndrome. The examiner must review the claims file, and a copy of this Remand. Following a review of the record, for each currently diagnosed disability, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) the Veteran's disability: a) had its clinical onset during active service, manifested within one year of service, or is otherwise related to any in service disease, event, or injury, to include the Veteran's documented in-service motor vehicle accident or other relevant trauma experienced by the Veteran in-service; b) is proximately due to the Veteran's headache disability; c) is aggravated beyond its natural progression by the Veteran's headache disability. The examiner must specifically address the following: 1) VA treatment records from May 1987, less than 6 months after the Veteran's separation from service, for dizzy spells and a diagnosis of possible vertigo; 2) VA treatment records from April 2000 for dizzy spells accompanied by headaches; and 3) buddy statements from the Veteran's older sister and his spouse describing symptoms of dizziness after he returned home from active duty service. (Continued on the next page) A complete rationale must be provided for all opinions. KRISTIN E. NEILSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Caban, 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.