Citation Nr: 21030490 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 16-02 397 DATE: May 19, 2021 REMANDED Entitlement to service connection for a low back disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1971 to November 1974. This matter is on appeal from a September 2012 rating decision. In July 2017, the Veteran testified at a videoconference hearing before the undersigned. A transcript of this hearing is associated with the record. In August 2018, this matter was remanded by the Board for further development to include obtaining private treatment records and an etiological opinion regarding the Veteran's low back disability. Pursuant to the Board's remand, on October 2019 VA back Disability Benefits Questionnaire examination the examiner diagnosed lumbosacral strain and degenerative arthritis of the spine which the examiner opined is not etiologically related to the Veteran's service. However, in May 2021 Brief, the Veteran, through his representative, raised the theory that his current low back disability may be related to an in -service incident involving an accidental dividing of his ileoinguinal nerve during hernia surgery. The service treatment records include a November 1973 report which shows that the Veteran's ileoinguinal nerve was accidentally divided during a right inguinal herniorrhaphy. The representative cited a medical article which states that if pain starts after pelvic surgery it may occur immediately over several years after surgery as the discomfort may arise from scar tissue. Since it is unclear whether there was any relationship between the Veteran's low back disability and ilioinguinal nerve surgery during service or service-connected inguinal hernia, on remand an addendum medical opinion should be obtained. The matter is REMANDED for the following action: Obtain an appropriate addendum by an examiner regarding the nature and etiology of the Veteran's low back disability. Unless the examiner finds that a new examination is required, the Veteran need not be examined again. The claims file, including a copy of this remand, must be made available to the examiner for review who should indicate that the claims file was reviewed. The examiner should provide the following opinion(s): a) Is it at least as likely as not (50 percent or more probability) that a low back disability had its onset in or is etiologically-related to the Veteran's active duty service, including an ileoinguinal nerve accidentally divided during a right inguinal herniorrhaphy in November 1973? b) If the answer to part (a) above is "no," is it at least as likely as not (50 percent probability or more) that the Veteran's low back disability is (a) proximately due to or the result of the Veteran's service-connected inguinal hernia, right status post-surgery, or (b) aggravated (any incremental increase in the low back disability beyond its normal progression) by his service-connected inguinal hernia, right status post-surgery? If it is determined that the low back disability is related to a service-connected disability, to the extent possible, the examiner should indicate the approximate degree of disability or baseline before the onset of aggravation. The examiner is asked to consider and discuss as necessary the pertinent evidence of record to include the Veteran's lay statements, testimony and complaints concerning the onset of low back disability, including those made to medical providers and May 2021 Brief. The Board, by this remand, makes no determination, expressed or implied, concerning the credibility of any statements on file. (Continued on the next page) The report should include the complete rationale for all opinions expressed. The phrase "at least as likely as not" does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Adams, 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.