Citation Nr: 21028714 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 14-22 396 DATE: May 11, 2021 REMANDED Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from June 1984 to July 1991 and from December 2004 to April 2006. This issue comes before the Board of Veterans' Appeals (Board) on appeal from a March 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. The issue on appeal was before the Board in February 2019, at which time the Board denied entitlement to service connection for a cervical spine disorder. Thereafter, the Veteran appealed this decision to the Court of Appeals for Veterans Claims (the Court). In January 2020, a Joint Motion for Remand (JMR) was granted by the Court, vacating the Board decision and remanding the issue back to the Board for additional development. In compliance with the JMR, the Board remanded the issue for a new VA examination in July 2020. Unfortunately, the Board finds that the additional development has not been completed. Stegall v. West, 11 Vet. App. 268, 271. The Veteran contends he is entitled to either direct or secondary service connection for his cervical spine disorder. The Board notes that this claim was remanded in July 2020 for additional development. Specifically, the Board requested the examiner address "whether the cervical spine disorder was caused or aggravated by his service-connected lumbar spine disability. The examiner is to render opinions on both causation and aggravation." See July 2020 Board Decision. In October 2020, a VA examination was completed. See October 2020 VA Opinion. The examiner opined that the Veteran had a low back injury during service which could not "spread" or "travel" to the Veteran's neck. The examiner opined that he or she was "unable to determine a clear nexus between active service injury and symptoms that developed after separation." In February 2021 an addendum opinion was completed. See February 2021 VA Addendum Opinion. The examiner rendered a negative opinion and requested that the October 2020 opinion be disregarded. The examiner noted diagnoses of degenerative arthritis, IVDS, and degenerative disc disease. However, after reviewing the Veteran's lay statements regarding the 1988 fall from the tank and number of years before the Veteran reported neck pain, the examiner opined that the Veteran's cervical spine disorder was not caused by or related to his cervical spine disorder. The examiner also gave a negative opinion that the Veteran's cervical spine disorder was caused by his lumbar spine disorder, noting that the Veteran's cervical spine condition is consistent with the progression of aging and natural wear and tear of the cervical spine joints. The Board regrets the additional delay; however, a remand is necessary to ensure the Veteran receives an adequate examination. A remand by the Board imposes upon the Secretary of VA a concomitant duty to ensure compliance with the terms of the remand. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268. The VA also has a duty to assist veterans in developing their claims for benefits. 38 C.F.R. § 3.159. The duty to assist includes providing a medical examination when necessary to decide a claim. 38 C.F.R. § 3.159 (c)(4). Once VA undertakes the effort to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311. The examiner failed to render an opinion as to whether the Veteran's cervical spine disorder was aggravated beyond its natural progression by the Veteran's service-connected low back disability. See February 2021 VA Opinion. Based on the examiner's failure to render an opinion as to low back disability, there was not substantial compliance with the Board's remand instructions, so the Board must remand this matter for an addendum VA medical opinion to address this. The matter is REMANDED for the following action: 1. Obtain updated VA and/or private treatment records to the extent possible. If such records are unavailable, the Veteran's claims file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Return the claims file to the examiner who conducted the February 2021 VA examination and request that they prepare an addendum to the examination report which addresses the question below. The claims file must be made available to the examiner. The examiner should note in the examination report that the claims file has been reviewed. If the examiner determines that another VA examination is necessary, one should be scheduled (or a telehealth interview if an in-person examination is not feasible). If the examiner who conducted the February 2021 VA examination is not available, arrange to obtain the requested opinion from a suitably qualified health care professional. Based on a review of the record, and a new examination if necessary, the reviewer must address the following: (a.) Whether it is at least as likely as not that the cervical spine disorder was caused or aggravated by the service-connected lumbar spine disability? The examiner is to render opinions on both causation and aggravation. 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. "Aggravation" means any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease, and not due to the natural progress of the nonservice-connected disease. If aggravation is found, the examiner should attempt to quantify the extent of additional disability resulting from the aggravation. In rendering this opinion, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. The examiner is not to improperly discount the Veteran's lay statements or rely solely on an absence of medical evidence in the record to support his or her conclusions. The examiner is to address and reconcile, to the extent possible, the VA examination report with the:(1) July 2017 private nexus opinion; (2) August 2017 private nexus opinion; (3) February 2018 VA examination report; (4) October 2020 VA examination and opinion; and (5) February 2021 VA opinion. A complete rationale must be provided for all opinions presented. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.