Citation Nr: 21029735 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 16-34 079 DATE: May 14, 2021 REMANDED Entitlement to service connection for cervical spine disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for thoracic and lumbar spine disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral upper extremities associated with and/or secondary to cervical spine disorder is remanded. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities associated with and/or secondary to thoracic and lumbar spine disorder is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty with the Army from September 1990 to December 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a Board video conference hearing in March 2019. A transcript of the proceeding has been associated with the claims file. The Board previously remanded this case in October 2019 and December 2020. Unfortunately, the Board finds that another remand is necessary in order to comply with its prior remand directives. Entitlement to cervical spine disorder, to include as secondary to service-connected disabilities, and entitlement to service connection for thoracic and lumbar spine disorder, to include as secondary to service-connected disabilities, are remanded. The Board remanded these issues to obtain an addendum opinion as to whether the Veteran's cervical, thoracic and lumbar spine disabilities are secondary to the Veteran's service-connected disabilities. The January 2021 VA examiner opined that the current neck condition and back condition are less likely than not secondary to the service-connected foot, ankle, or knee conditions; nor has the neck or back condition been aggravated (as defined for VA purposes) by the aforementioned service-connected conditions. The only rationale provided was that there is nothing in the currently accepted, peer reviewed, credible, and authoritative orthopedic literature that supports the contention of a neck condition (disc disease, stenosis, and myelopathy) or back condition (disc disease, stenosis, facet arthropathy, etc.) as being secondary to a bilateral or unilateral foot, ankle, or knee condition with or without altered gait pattern and/or surgical intervention. Unfortunately, the Board finds that the VA examiner failed to provide an adequate rationale for the opinions given. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this regard, the examiner did not discuss or cite the medical literature reviewed; or explain how the medical literature applied to the Veteran's specific circumstances. An opinion without further explanation based solely on the lack of medical literature supporting a claim is inadequate. See Mattern v. West, 12 Vet. App. 222, 228 (1999). Further, the examiner did not specifically address the Veteran's symptoms, including his altered gait, as directed by the Board. Moreover, the VA examiner improperly mixed causation and aggravation when addressing secondary service connection, instead of providing a separate rationale that dealt with causation and aggravation as independent concepts. Atencio v. O'Rourke, 30 Vet. App. 74, 90-91 (2018). Thus, in order to comply with the prior Board remand directives, another opinion must be obtained. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for peripheral neuropathy of the bilateral upper and lower extremities are remanded. As noted in the prior remand, as the evidence appears to indicate that the Veteran's peripheral neuropathy of the bilateral upper and lower extremities is associated with the Veteran's spinal disabilities, these issues are inextricably intertwined. As such, a remand of these claims is required. Entitlement to a TDIU is remanded. Likewise, the issue of entitlement to a TDIU is also inextricably intertwined with the remaining issues on appeal. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Moreover, the Board previously remanded this issue to obtain appropriate VA examinations to address the functional impairment the Veteran's service-connected disabilities have on his activities of daily living and the effect on his employment. The Veteran was afforded a VA mental disorders examination in December 2020. However, the examiner, while noting that the Veteran was not employed, did not discuss whether the Veteran's psychiatric symptoms, including depressed mood, anxiety, and chronic sleep impairment, caused any effect on his employment. Thus, the Board finds that addendum opinion is necessary with respect to this disability. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an orthopedic specialist, if possible, regarding the nature and etiology of the Veteran cervical spine disorder and thoracic/lumbar spine disorder. The need for another examination is left to the discretion of the examiner. With respect to any diagnosed cervical, thoracic and lumbar disabilities, the examiner must opine whether it is at least as likely as not (1) proximately due to service-connected disabilities, or (2) aggravated (any incremental increase, even transient) by service-connected disabilities. A detailed rationale for all opinions given must be provided. The examiner must provide a separate rationale with respect to causation and aggravation. The examiner must discuss the Veteran's altered gait due to his service-connected disabilities. The examiner is advised that an opinion based solely on the lack of medical literature supporting a claim is inadequate. If the VA examiner opines that the spinal disorders are secondary to the Veteran's service-connected disabilities, the examiner must opine whether the Veteran's peripheral neuropathy of the bilateral upper and lower extremities is at least as likely as not (1) an associated neurological abnormality of his spinal disorder and/or proximately due to the spinal disorders, or (2) aggravated (any incremental increase, even transient) by the spinal disorders. 2. Obtain an addendum opinion from the VA mental disorder examiner who conducted the December 2020 VA examination or another appropriate clinician. The need for another examination is left to the discretion of the examiner. The examiner must discuss the Veteran's ability to function in an occupational environment and describe the functional effects of the Veteran's service-connected mental disorder on his employment. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.N. Moats 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.