Citation Nr: 21028300 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 11-30 363 DATE: May 10, 2021 REMANDED Entitlement to service connection for a low back disorder, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran was inducted into active duty service in March 1969 and remained in service to March 1971. This case originally came before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This claim was last before the Board in November 2018. Unfortunately, the Board must again remand the low back disorder claim in order to obtain an adequate medical opinion, as discussed below. 1. Entitlement to service connection for a low back disorder, to include as secondary to service-connected disabilities, is remanded. A remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). While substantial compliance is required, strict compliance is not. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (citing Dyment v. West, 13 Vet. App. 141, 146-47 (1999)). In November 2018, the Board remanded this issue with instructions to obtain a VA addendum opinion regarding the etiology of the Veteran's low back disorder, specifically whether it at least as likely as not was caused or aggravated by his service-connected left hip, left thigh, or left knee disorders, along with supporting rationale. In September 2019, the Veteran was provided a VA examination, at which time the examiner opined that the Veteran's low back disorder was less likely than not proximately due to or the result of the Veteran's service-connected left hip, left thigh, and/or left knee disabilities. The examiner explained that the Veteran reported that his back pain started around 2004 or 2005 with no apparent injury; and that magnetic resonance imaging (MRI) at that time revealed spondylosis of the low back, which was consistent with the age of the Veteran at the time and which was many years after separation from service. The examiner noted that, although a private physician provided nexus opinions, he did not provide adequate rationale. The VA examiner also opined that the Veteran's low back disorder was less likely than not aggravated beyond its natural progression by his service-connected left hip, left knee, and left thigh disabilities. However, the examiner cut and pasted the same rationale for this opinion. Unfortunately, the explanation and rationale provided regarding causation by the service-connected disabilities do not adequately explain the opinion regarding aggravation by the service-connected disabilities. Specifically, the timing of the onset of low back symptoms, whether they were related to an injury, and whether MRI findings were consistent with age do not explain whether the low back disorder was aggravated by his service-connected disabilities. Although a December 2020 VA back examination report is also associated with the claims file, it primarily focuses on claimed radiculopathy in the lower extremity and does not include an opinion regarding aggravation of the Veteran's low back disorder due to service-connected disabilities. As noted by the September 2019 VA examiner, the positive private opinions did not include adequate rationale. There is no other competent, adequate opinion provided to address whether the Veteran's low back disorder was aggravated by his service-connected disabilities. As such, an addendum is required in order to more completely address the etiology of the Veteran's claimed low back disorder. The matter is REMANDED for the following action: 1. Obtain an addendum opinion by a VA orthopedist with regard to the Veteran's low back disorder. The need for another examination is left to the discretion of the examiner. After reviewing the claims file, the examiner is asked to: Provide an opinion as to whether the Veteran's low back disorder was caused by, aggravated by, or related in any way to the Veteran's service-connected left hip, left thigh, and/or left knee disabilities. ** The questions of causation AND aggravation MUST both be addressed. ** A COMPLETE rationale should be provided for all opinions on causation AND aggravation. (Continued on the next page) 2. Thereafter, readjudicate the remanded claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee, 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.