Citation Nr: 21028140 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 16-30 171 DATE: May 10, 2021 REMANDED Entitlement to service connection for a neck disorder is remanded. REASONS FOR REMAND The Veteran served active duty in the United States Navy from August 1976 to May 1982. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office. This matter was reopened and remanded by the Board in September 2018. In October 2019, the matter was remanded again for further development. It has now been returned to the Board for appellate review. Unfortunately, a review of the claims file reveals that remand is necessary once again. Initially, the Board notes that private medical records pertinent to the appeal and part of the Board's October 2019 remand directive were added to the claims file after the January 2020 VA examination. As such, they were not considered by the examiner and therefore, an addendum opinion is warranted. Moreover, at the time of the January 2020 VA examination, the examiner opined that it is less likely than not the Veteran's current degenerative disc disease of the cervical spine is related to his1979 chiropractic manipulation. While he acknowledged the lay statements of the Veteran and his spouse, he noted that the Veteran's 1982 separation examination and the October 1991 U.S. Navy Reserve examination did not show an issue. He further added that 1988 medical assessments were negative for neck pain, and no imaging was conducted until August 2005. The examiner questioned that if the Veteran has been experiencing pain since service that imaging would have been done within the 26- year period, between his service and 2005. Therefore, he found no chronicity was established and opined that the Veteran's neck disorder is a genetic predisposition since the Veteran has low back degenerative disc problems. The Board finds the opinion to be inadequate as the examiner's opinion only addressed whether the Veteran's neck disorder was related to manipulations done while in service. In an October 2012 statement, the Veteran indicated that while in active duty he was lifting and lowering crated equipment when he felt a stabbing pain in his lower back. However, he stated he also experienced pain in his neck and shoulders at that time and that the pain has continued since. An opinion was not provided that discussed whether his duties in service, including lifting and lowering of the crated equipment, could have caused his neck disorder. Moreover, the opinion appears to rely on an assumption by the VA examiner that if the Veteran was experiencing pain since service, testing would have been done and complaints would have been included in the record. An opinion regarding the medical etiology and development of degenerative disc disease of the neck would be helpful. Specifically, an opinion regarding whether manipulations of the neck or the Veteran's in-service duties could cause degenerative disc disease or any other diagnosed neck disorder. The Board also notes that, in an August 2020 brief, the Veteran's representative appears to have asserted that the Veteran's neck disorder was caused or aggravated by his service-connected lumbar spine disability. Specifically, she indicated that the January 2020 VA examiner failed to show the likelihood or unlikelihood of neck pain resulting from the Veteran's chiropractic treatment for his service-connected disability, and how the manipulations of the lower back could have attributed to residual neck pain. For the reasons stated above, remand is necessary for another VA examination and medical opinion. The matters are REMANDED for the following action: The Veteran should be afforded a VA examination to determine the nature and etiology of any neck disorder that may be present. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and lay assertions. The examiner should state whether it is at least as likely as not (50 percent probability or greater) that the Veteran has a neck disorder manifested in service or is otherwise causally or etiologically related to the Veteran's military service, to include any injury, chiropractic manipulations, or symptomatology therein. The Veteran has asserted that his neck disorder is related to chiropractic manipulations conducted in service for his back and neck. Moreover, in an October 2012 statement, the Veteran indicated that he lifted and lowered crated equipment while in service. The examiner is advised that a medical opinion which concludes that a disability is not related to service solely because there is absence of medical records is inadequate. The examiner should also provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's neck disorder was either caused or aggravated by the Veteran's service-connected lumbar spine disability, including chiropractic manipulations conducted to treat the lumbar spine disability. The Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (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 conclusion is so evenly divided that it is as medically sound to find favor of conclusion as it is to find against it.) A clear rationale for the opinion would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M. Walker 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.