Citation Nr: 21027276 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 15-16 018 DATE: May 5, 2021 REMANDED Entitlement to service connection for back condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1979 to January 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision of a U.S. Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In September 2017, the Veteran testified before the undersigned Veterans Law Judge. A transcript is of record. This issue was previously before the Board, most recently in July 2020. Entitlement to service connection for back condition is remanded. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issues of entitlement to service connection for back condition. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The July 2020 Board remand order directed the RO to advise the VA examiner that the Veteran's report of an in-service injury due to lifting a heavy tire during active duty and back pain beginning at that time and continuing to the present had been found to be credible. The Board directed the VA examiner to consider and address this credible evidence when formulating a causation opinion. The September 2020 VA addendum medical opinion, however, did not address the Veteran's September 2017 testimony and did not reflect consideration of the Veteran's symptoms of back pain ever since active duty service. Indeed, the September 2020 VA examiner largely reiterated the examiner's own July 2019 medical opinion that had already been found to be inadequate by the Board. Another addendum VA medical opinion addressing the Veteran's lay statements about symptoms since service is warranted. The matter is are REMANDED for the following actions: 1. Obtain updated VA and/or private treatment records. If any identified 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). 2. Obtain an addendum opinion from an appropriate clinician, regarding the Veteran's back condition. If possible, the opinion should be from a different clinician than the September 2020 VA addendum opinion. The examiner must review the claims file, including a copy of this remand order and the September 2017 hearing transcript. The Veteran denied back problems prior to service. The Veteran testified that to a groin and back injury in service while moving a 200-pound semi-truck tire. The Veteran testified to still having back pain at separation and had pain ever since this in-service injury that predated any post-service back incidents. The Veteran testified that he chose to drink rather than seek narcotic medication for pain. The undersigned Veterans Law Judge found this testimony truth and credible. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the Veteran's back condition at least as likely as not related to service, including the in-service tire lifting accident? 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. Provide a rationale to support the opinions. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). In providing the requested opinion, consider the Veteran's description of in-service injury and symptoms as well as his post-service symptoms. The examiner is advised that the Veteran's testimony an in-service injury due to lifting a heavy tire during active duty and back pain beginning at that time and continuing to the present has been found to be credible. The examiner should consider and address this credible evidence. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of current disability, this should be noted. Stated another way, do the Veteran's reports about symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.