Citation Nr: 21027670 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 14-24 088A DATE: May 6, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from July 1954 to July 1957. He had additional Reserve and National Guard service, including periods of active duty for training (ACDUTRA) and inactive duty training (INACDUTRA). This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). An informal hearing conference with a Decision Review Officer (DRO) was conducted in June 2014 in lieu of a formal hearing. The Veteran initially requested a hearing before the Board on his July 2014 VA Form 9; however, he failed to appear for his scheduled Board hearings in August 2017 and May 2018 and to date has not requested his hearing be rescheduled. Thus, the Veteran's hearing request is therefore considered withdrawn. See 38C.F.R. §20.704(d). The Board remanded the appeal for further development in October 2017, July 2018, January 2020, and November 2020. The Board regrets additional delay, but unfortunately, another remand is required. Pursuant to the Board's most recent remand directives in November 2020, an addendum opinion was obtained in February 2021. The Board asked the examiner to opine on whether any cervical spine disability experienced by the Veteran since approximately February 2011 at least as likely as not (1) began during or is related to his period of active duty service from July 1954 to July 1957 or any period(s) of ACDUTRA or INACDUTRA; (2) manifested within one year after discharge from his period of active duty service from July 1954 to July 1957; (3) is related to an in-service injury or disease during any period(s) of active duty service, ACDUTRA, or INACDUTRA; OR (4) was aggravated by any period(s) of ACDUTRA or INACDUTRA(to include any period(s) of ACDUTRA or INACDUTRA following his February 1974 injury, either individually or collectively). In addressing these questions, the Board specifically asked the examiner to: acknowledge and discuss the medical opinions that the Veteran's cervical spine disability likely pre-existed his February 1974 neck injury (see e.g., the letters from H.G. White, Jr., MD dated in October 1975, November 1975, and January 1983, which suggest that the Veteran's cervical spine disability was already present at the time of his February 1974 injury). The clinician should also note the August 2019 "Official Memo of Service," which indicates that the Veteran had numerous periods of ACDUTRA and INACDUTRA (to include during periods following his February 1974 injury). However, the February 2021 VA examiner did not address any of the questions outline above and instead, the examiner provided a cursory opinion with inadequate rationale. Thus, an addendum opinion is needed on remand from a different examiner to ensure substantial compliance with the Board's November 2020 remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Any outstanding treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then obtain an addendum opinion from a VA examiner other than the November 2017, September 2019, September 2020, and February 2021 examiners, preferably a physician, to determine the etiology of the Veteran's cervical spine disability. The claims file, to include a copy of this remand, must be made available to the examiner for review, and the examination report must reflect that such a review was accomplished. The examiner is requested to provide an opinion as to the following questions: (a). Identify all neck disabilities diagnosed since January 2011, even if resolved, to include ankylosing spondylitis and degenerative arthritis of the cervical spine. If any of the diagnoses are not warranted, please reconcile these findings with the diagnoses of the same in the November 2017 and September 2019 VA examination and imaging reports. (b). For diagnosed ankylosing spondylitis, please determine whether such diagnosis is a congenital defect or disease. (For VA purposes, a defect differs from a disease in that the former is more or less stationary in nature while the latter is capable of improving or deteriorating.) (c). If ankylosing spondylitis is identified as a congenital defect, please opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran incurred any superimposed disease or injury on such defect during service from July 1954 to July 1957 or during a period of ACDUTRA or any superimposed injury on such defect during a period of INACDUTRA that resulted in additional disability. If so, please describe the resultant disability. (d). If ankylosing spondylitis is identified as a congenital disease, please opine as to whether it is at least as likely as not (50 percent or greater probability) that such disease was aggravated (worsened beyond natural progression) by service from July 1954 to July 1957 or during a period of ACDUTRA. (e). If ankylosing spondylitis does not have a congenital origin, or for any other neck disability diagnosed including degenerative arthritis, please opine as to whether it is at least as likely as not (50 percent or greater probability) that such disability: (1) had its onset in service from July 1954 to July 1957 or during a period of ACDUTRA; (2) in the case of arthritis, manifested within one year of discharge from service in July 1957; (3) is related to disease or injury incurred or aggravated in line of duty during service from July 1954 to July 1957 or during a period of ACDUTRA; or (4) is related to injury incurred during a period of INACDUTRA; or (5) was aggravated by any period of ADUTRA or INACDUTRA following his February 1974 injury, either individually or collectively. In addressing these questions, please provide a discussion of whether a relationship between the Veteran's cervical spine disability and service is medically consistent with his service treatment records (STRs) that document a neck injury and numerous complaints of neck pain. See May 1974, May 1975, and September 1976 Reserve STRs. Please also acknowledge and discuss the medical opinions that the Veteran's cervical spine disability likely pre-existed his February 1974 neck injury (see e.g., the letters from H.G. White, Jr., MD dated in October 1975, November 1975, and January 1983 which suggest that the Veteran's cervical spine disability was already present at the time of his February 1974 injury). A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion without speculation, please indicate whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.