Citation Nr: 21028616 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-34 133 DATE: May 11, 2021 REMANDED Entitlement to service connection for a cervical spine disability, to include as secondary to a lumbar spine disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for costochondritis (also claimed as chest pain) is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1983 to May 2005. This matter comes before the Board of Veterans' Appeals (Board) from a May 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claims were remanded in August 2019 in order to obtain VA medical examinations and medical opinions addressing the various theories of entitlement for service connection. For reasons detailed below, the Board finds that its remand directives were not substantially complied with. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for a cervical spine disability, to include as secondary to a lumbar spine disability is remanded. Upon review of the January 2020 VA medical opinion addressing the Veteran's secondary service connection theory of entitlement, the Board finds it inadequate for purposes of adjudicating the Veteran's claim in that the VA examiner did not specifically address any of the Veteran's service-connected disabilities relative to her claimed for cervical spine condition, to include as to whether any of those service-connected disabilities aggravate her claimed for cervical spine condition beyond its natural progression. Rather, the January 2020 VA medical examiner merely cited to medical literature without applying it to the specific facts of the Veteran's case, especially as it relates to her secondary service connection theory of entitlement as due to her service-connected lumbar spine disability, and therefore the Board finds the medical opinion to be inadequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 2. Entitlement to service connection for a left hip disability is remanded. Upon review of the January 2020 VA medical opinion obtained on remand, the Board finds that its remand directives were not substantially complied with as the VA examiner was merely requested to opine as to whether the Veteran's claimed for left hip condition is proximately due to, and/or aggravated beyond its natural progression by her service-connected knee disability. Rather, per its August 2019 remand directives, the Board had requested a medical opinion addressing whether the Veteran's claimed for hip disability is proximately due to and/or aggravated beyond its natural progression by any of the Veteran's service-connected disabilities. Accordingly, an addendum medical opinion must be sought upon remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order). 3. Entitlement to service connection for costochondritis (also claimed as chest pain) is remanded. Upon remand, the January 2020 VA examiner opined that the Veteran does not have a current diagnosis of costochondritis given the Veteran's statements during the examination that she is not suffering from chest pain/is not being treated for costochondritis. See January 2020 VA examination report. Per the December 2014 VA examination report, the Veteran was diagnosed with costochondritis. The Veteran has also provided consistent and competent lay testimony that she often suffers from chest pain and has ever since service. See July 2016 VA Form 9; August 2016 Statement of Representative in Appeals Case; Additional Evidence for NOD Dated 29 May 2015. Additionally, the January 2020 VA examiner associated the Veteran's complaints of chest pains with her diagnosis of costochondritis, and therefore the Board finds that a new medical opinion must be obtained to address the conflicting medical evidence of record, namely whether her complaints of chest pain, in tandem with the December 2014 diagnosis, directly relate to her diagnosis in service, as opposed to the January 2020 VA examiner's medical opinion that she does not currently suffer from costochondritis. See Service Treatment Records (STRs). The matters are REMANDED for the following action: 1. Associate with the Veteran's claims file any outstanding VA treatment records since February 2020. 2. Thereafter, obtain addendum medical opinions for the claims on appeal. Upon review of the pertinent evidence of record, to include this remand, and as indicated below, the VA examiner is requested to opine as to the all of the following (if in-person VA examinations are deemed necessary, please schedule them): For the claimed for cervical spine condition... a. Is it at least as likely as not (50 percent probability or greater) that the Veteran's claimed for cervical spine condition is proximately due service-connected disability to include, but not limited to, her service-connected lumbar spine disability, and/or aggravated beyond its natural progression by service-connected disability, to include, but not limited to, her service-connected lumbar spine disability? If studies or medical literature are referenced/relied upon by the VA examiner, then those same principles must be applied to the specifics of this Veteran's medical history. For the claimed for left hip condition... b. Is it at least as likely as not (50 percent probability or greater) that the Veteran's hip pain (coupled with functional loss) is proximately due to, and/or aggravated beyond its natural progression by any of her service-connected disabilities? If studies or medical literature are referenced/relied upon by the VA examiner, then those same principles must be applied to the specifics of this Veteran's medical history. For the claimed for costochondritis condition... c. Is it at least as likely as not (50 percent probability or greater) that the Veteran's complaints of chest pain and diagnosis of costochondritis during the pendency of her claim directly relate to her in-service diagnosis of costochondritis? If studies or medical literature are referenced/relied upon by the VA examiner, then those same principles must be applied to the specifics of this Veteran's medical history. The VA examiner should specifically address the Veteran's complaint of experiencing chest pain ever since service, as well as the December 2014 examination report noting a diagnosis of costochondritis. See VBMS, document labeled "C&P Exam," receipt date April 7, 2015 (diagnosing the Veteran with costochondritis during the pendency of her claim); VBMS, document labeled "Form 9," receipt date July 18, 2016; VBMS, document labeled "VA 646 Statement of Accredited Representative in Appealed Case," receipt date August 12, 2016; VBMS, document labeled "Correspondence," receipt date June 24, 2015. K. Anderson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.R. Fey, 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.