Citation Nr: 21029358 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 15-45 924 DATE: May 13, 2021 REMANDED Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected lumbar spine disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1992 to December 1994. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. In March 2020, the Board, in pertinent part, denied the Veteran's claim for service connection for a cervical spine disorder, to include as secondary to service-connected lumbar spine disability. The Veteran appealed the March 2020 Board decision to the United States Court of Appeals for Veterans Claims (CAVC). In a Joint Motion for Partial Remand (JMPR), the CAVC vacated and remanded the portion of the Board's decision that denied entitlement to service connection for a cervical spine disorder based on aggravation by a service-connected disability (lumbar spine disability). Specifically, the JPMR indicates that the Board relied on a July 2019 medical opinion that failed to provide an adequate opinion regarding aggravation. The JPMR thus instructs that a remand for a new medical opinion that adequately addresses the issue of aggravation is necessary. The matter is now again before the Board for action consistent with the terms of the JMPR. Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected lumbar spine disability, is remanded. Once VA undertakes the effort to provide an examination in connection with a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one, or at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion will be considered adequate when it is based upon consideration of the Veteran's prior medical history and examinations and provides a sufficiently detailed description of the disability so that the Board's evaluation will be a fully informed one. Id.; Green v. Derwinski, 1 Vet. App. 121, 124 (1991). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, aggravation of a condition by a service-connected disability must be considered independently of direct causation, and medical examinations must provide adequate reasoning and conclusions on both points. Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018). In a July 2019 VA opinion, the examiner opined that the Veteran's cervical spine disorder was less likely than not aggravated by his service-connected lumbar spine disability. In support of this conclusion, the examiner stated that there was no medical evidence to support neck pain in service and the Veteran's records indicate that his neck pain started in 2011, years after service. However, while the examiner provided an aggravation opinion, the examiner's rationale failed to adequately explain why the Veteran's cervical spine disability was not at least as likely as not aggravated by his service-connected lumbar spine disability. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that medical opinions addressing the issue of secondary service connection are inadequate when they fail to adequately encompass the question of aggravation). Thus, the July 2019 VA opinion addressing aggravation is inadequate, and a new VA opinion is necessary to adjudicate the claim. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the nature and etiology of the Veteran's cervical spine disorder. The electronic claims file must be made accessible to the examiner for review in conjunction with the examination. The VA examiner should address whether the Veteran's cervical spine disorder is at least as likely as not (50% probability or greater) aggravated (increased in severity beyond the natural progress of the disorder) by his service-connected lumbar spine disorder. An explanation of all opinions expressed must be provided, with consideration given to all evidence of record. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hite, 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.