Citation Nr: 21029179 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 16-10 066 DATE: May 12, 2021 REMANDED Entitlement to service connection for a back disability, to include as secondary to service-connected bilateral knee disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to March 1987. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Board reopened the Veteran's claim for service connection for a back disability and remanded the matter for further development. Service Connection for a Back Disability The Board regrets further delay, but additional development is necessary before the matter can be adjudicated. Specifically, the Board finds that remand is required in order to obtain an adequate VA medical opinion. Where VA provides a veteran with an examination in a service connection claim, the examination and medical opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Pursuant to the Board's remand directives, the Veteran was afforded a VA examination in January 2020. The examiner opined that the Veteran's back disability is less likely than not due to service as degenerative disc disease (DDD) is an age-related condition. However, the examiner later contradicted herself by opining that the Veteran's back disability is at least as likely as not related to service as the Veteran's service treatment records (STRs) noted diagnosis of lumbosacral strain and continued treatment for a chronic lower back condition post-service. The Board notes that the examiner failed to provide a thorough rationale for this conclusion. A July 2020 addendum medical opinion concluded that the Veteran's back disability is less likely than not related to service. The examiner reasoned that the Veteran's low back pain/strain resolved by the time of separation from service in March 1987. The examiner further reasoned that the Veteran's DDD of the lumbar spine was not diagnosed until approximately 20 years after separation from service. The Board notes that the examiner failed to consider the Veteran's lay assertions regarding onset and duration of symptoms. Regarding secondary service connection, the examiner opined that the Veteran's back disability has not been aggravated beyond natural progression by his service-connected left knee disability. She reasoned that periodic medical examinations of record reveal reports of intermittent left knee pain, but no evidence of low back problems or pain. The Board notes that the examiner failed to provide a clear rationale as to whether the Veteran's back disability has been aggravated by his service-connected disabilities. Additionally, it appears that the examiner only considered the Veteran's service-connected left knee disability in her opinion; however, the Veteran is also service-connected for a right knee disability. As there is no adequate medical opinion on which to adjudicate the matter, the Board finds that remand is necessary to obtain a new VA examination and medical opinion regarding the nature and etiology of the Veteran's back disability. The matter is REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, schedule the Veteran for an examination to determine the nature and etiology of the Veteran's back disability. Following a review of the claims file, the examiner is asked to opine as to the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's back disability began in or is otherwise etiologically related to service? b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's back disability is proximately due to, the result of, his service-connected bilateral knee disabilities? c) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's back disability has been aggravated by his service-connected bilateral knee disabilities? In rendering the requested opinions, the examiner should consider and address the Veteran's lay statements regarding onset and continuity of symptoms. A complete rationale must be provided for all opinions expressed. If an opinion cannot be offered without resort to mere speculation, the examiner must indicate why this is the case and what additional evidence, if any, would allow for a more definitive opinion. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Robinson, 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.