Citation Nr: 21029985 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 14-03 129 DATE: May 17, 2021 REMANDED The appeal for entitlement to service connection for a lumbar spine disability, to include degenerative disc disease and degenerative joint disease with HLA B-27 positive genetic status is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1966 to August 1968. This matter comes before the Board of Veterans' Appeals (Board) from an August 2010 decision by the Agency of Original Jurisdiction (AOJ). The appeal was remanded by the Board in June 2015 and again in November 2017. The Board denied the appeal in November 2019. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In January 2021, the Court vacated the Board's November 2019 denial, and remanded the matter in accordance with the terms of a Joint Motion for Remand filed by both parties to the case. The Veteran is seeking service connection for a lumbar spine disability on the basis that a genetic disorder was aggravated during service, hastening the development of degenerative disease. Alternatively, he is contending that his genetic disorder was initially manifested, or initially became symptomatic during service. He asserts that during service he would miss physical training due to back pain. He also asserts that jumping out of trucks during service aggravated his back pain. An additional factor which may be relevant is that the Veteran had rheumatic fever at age eight, prior to service. His childhood rheumatic fever was noted in the context of contemporaneous back pain during service. In denying the claim, the Board had relied upon a January 2018 VA medical opinion which the authors of the Joint Motion agreed was internally inconsistent. In the opinion the examiner concluded that the Veteran's degenerative disc disease and degenerative joint disease with a positive genetic status pre-existed service, but also concluded that there was no evidence of a spinal disorder prior to service, during service, or at separation. The Board deems that a better-explained medical opinion would be optimal here. Especially as medical knowledge and understanding surrounding diseases with a genetic origin or component is advancing rapidly, there may already be better understanding of the effects and impact of the Veteran's particular gene mutation. In addition to the reasons for remand discussed in the Joint Motion, the Board observes that the most recent medical treatment records available for review are dated in 2010. It appears that the Veteran receives private medical care; therefore, if he wishes the review of his claim to be fully informed, he is encouraged to release updated medical records to VA for review by adjudicators, and by the medical reviewer who will be providing the opinion requested above. If he has received VA medical care for his back, he must notify VA so that these records may be obtained in support of his appeal. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all medical care received for his back problems since 2010. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. After obtaining the records requested above, obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's currently shown lumbar degenerative disc disease and degenerative joint disease was initially manifested prior to, during, or within one year of discharge from service. In reviewing the Veteran's file, the reviewer is to give full credence to the Veteran's statements that he experienced back pain during service, to include when jumping in and out of trucks, and had to sit out physical training on account of back pain on at least several occasions. If it is concluded that the Veteran's back disability existed prior to service, the reviewer should fully discuss whether pre-service disability was aggravated beyond its natural progression during service. The impact of the Veteran's genetic status upon his current lumbar spine disease should be fully explained. (Continued on the next page) IF the reviewer deems that additional tests, studies and/or clinical examination would be helpful to reaching a fully informed opinion, then such tests, studies and/or clinical examination must be provided. Saudiee Brown Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Heather J. Harter, 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.