Citation Nr: 21029863 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 19-24 313 DATE: May 17, 2021 REMANDED Entitlement to service connection for a back disability, to include as secondary to a service-connected duodenal ulcer, is remanded. REASONS FOR REMAND The appellant had service in the Army National Guard, to include a period of active duty for training from April to October 1960. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In February 2021, the appellant testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the appellant's claim and to afford him every possible consideration. Entitlement to service connection for a back disability is remanded. The appellant seeks to establish service connection for a back disability. He asserts that his back disability began in service after he developed a duodenal ulcer. Alternatively, he asserts that his back disability is secondary to his service-connected duodenal ulcer. Specifically, he asserts that due to his duodenal ulcer, he lost abdominal strength, which caused him back pain. See, e.g., February 2021 Board hearing transcript. The appellant underwent a VA examination in October 2018. The examiner diagnosed degenerative arthritis of the lumbar spine and opined that the condition was less likely than not proximately due to or the result of the appellant's service-connected duodenal ulcer. In so doing, however, the examiner did not address the appellant's assertion that his back problems started in service, after developing the duodenal ulcer. Nor the did the examiner specifically address the appellant's theory that due to his duodenal ulcer, he lost abdominal strength, which resulted in back pain. The Board notes that secondary service connection may be granted for a disability that is proximately due to, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995). As the October 2018 examiner did not fully address the theories at issue, the examination is incomplete, and a remand is required to obtain an addendum opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). During the February 2021 hearing, the appellant indicated that he was receiving treatment for his back disability at Brigham and Women's Hospital in Boston, Massachusetts. He also indicated that a physician (Dr. Shields) had informed him that his back disability was related to his service-connected duodenal ulcer. While the claims file contains records of treatment from Brigham and Women's Hospital and Dr. Shields, it is not entirely clear that those records are complete. On remand, efforts should be made to obtain any additional, relevant records that might exist. See, e.g., 38 C.F.R. § 3.159(e)(2) (if VA becomes aware of the existence of relevant records before deciding a claim, VA will, among other things, request that the claimant provide a release for the records). This matter is REMANDED for the following action: 1. Ask the appellant to provide a release for any additional, relevant records of treatment that might be in the possession of Brigham and Women's Hospital and Dr. Shields, and to identify, and provide appropriate releases for, any other care providers who may possess new or additional evidence pertinent to the issue on appeal. If he provides the necessary release(s), assist him in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact, and the appellant and his representative should be notified. 2. Obtain copies of records pertaining to any VA treatment the appellant may have received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 3. After the foregoing development has been completed to the extent possible, make arrangements to return the claims file to the VA examiner who prepared the October 2018 VA spine examination report (or a suitable substitute if that VA examiner is unavailable) for the purpose of preparing an addendum opinion. If the examiner deems that another examination of the appellant is required, one should be undertaken. After reviewing the record, the examiner is requested to provide an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the appellant's current back disability had its onset in, or is otherwise attributable to, service. In doing so, the examiner is requested to address the appellant's statements to the effect that his back pain began in service, after he developed the duodenal ulcer. If it is the examiner's opinion that it is unlikely that the appellant's back disability had its onset in service or is otherwise related to service, the examiner should render a further opinion with respect to whether it is at least as likely as not that the back disability has been (a) caused or (b) aggravated (i.e., worsened beyond normal progression) by the appellant's service-connected duodenal ulcer. In doing so, the examiner should address the appellant's theory that due to his duodenal ulcer, he lost abdominal strength, which resulted in back pain. In that regard, the examiner should discuss the medical significance, if any, of the evidence reflecting that the appellant underwent surgery for diverticulitis in July 1988 involving a colectomy and colostomy; that he thereafter developed an incisional hernia; and that there is medical opinion evidence both for and against the proposition that the diverticulitis for which the appellant underwent surgery in 1988 was etiologically related to the earlier diagnosis of duodenal ulcer. A complete medical rationale for all opinions expressed must be provided. 4. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the appellant and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Ragheb, 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.