Citation Nr: 21031614 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 14-13 424 DATE: May 24, 2021 REMANDED Service connection for a cervical spine disability, to include as secondary to service-connected lumbar spine disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from March 1966 to June 1969 and from March 1976 to March 1980. The issue is on appeal from a January 2011 rating decision and the issue was last remanded by the Board of Veterans' Appeals (Board) for additional adjudication in October 2020. Service connection for a cervical spine disability, to include as secondary to service-connected lumbar spine disability, is remanded The Veteran seeks service connection for a cervical spine disability which he contends is due to lifting heavy equipment and cooking supplies as part of his military occupational specialty (MOS) duties or secondary to his service-connected lumbar spine disability. Pertinently, the Veteran was afforded a VA examination and an addendum opinion was obtained in March 2020 and April 2020, respectively. The examiner provided a negative etiology opinion for both direct and secondary service connection avenues. However, as stated in the October 2020 remand, the Board found the examiner's opinions less than probative as the examiner impermissibly relied on the absence of service treatment records, did not discuss the Veteran's MOS duties which required him to carry heavy equipment and cooking supplies, nor discuss the July 1978 notation of cervical thoracic scoliosis. Furthermore, the examiner only provided an opinion on the causation of whether the Veteran's cervical spine was caused by the in-service lumbar spine injury; not whether the Veteran's cervical spine was caused or aggravated by his service-connected lumbar spine disability. The October 2020 remand instructed that the Veteran should be scheduled for a new VA examination; he was examined in January 2021. However, the Board finds that once again, the VA examiner did not adequately comply with the Board's remand instructions and the examination is insufficient for adjudication purposes. The examiner was asked to provide etiological opinions based on the correct legal standards for direct or secondary service connection. In so doing, the examiner was instructed to specifically address the Veteran's July 1978 in-service diagnosis of cervical thoracic scoliosis and his MOS duties which included carrying heavy equipment and cooking supplies. Rather, the January 2021 examiner wrote under the medical history section that the Veteran reported having neck pain in 1978 from carrying heavy food packages by hand. The examiner ignored and did not consider the Veteran's July 1978 in-service diagnosis of cervical thoracic scoliosis. On remand, an addendum opinion should be obtained from the January 2021 examiner where he specifically acknowledges and considers the July 1978 in-service diagnosis of cervical thoracic scoliosis in addition to the Veteran's consistent lay statements of neck pain due to his MOS duties. The Board finds that an addendum opinion is also needed to obtain an opinion regarding secondary service connection between the claimed cervical spine disability and service-connected lumbar spine disability. The January 2021 examiner opined that the Veteran's cervical spine disability was less likely than not proximately due to or the result of his service-connected lumbar spine disability because the neck disability is a "totally different disease entity"; and that he could not determine a baseline of severity based upon medical evidence available prior to aggravation because there was no sufficient medical evidence to support the claim. The Board finds the rationale for the January 2021 examiner's negative opinion for secondary service connection is inadequate as the rationale requires more detail. The examiner's statement that the Veteran's claimed cervical spine disability is less likely than not due to or aggravated by his service-connected lumbar spine disability solely because "it is a totally different disease" is vague. On remand, a more thorough explanation is required. For the above reasons, an additional addendum opinion is needed as medical evidence was not appropriately discussed in full, indicating a potential lack of consideration for the Veteran's medical history, nor was thorough explanation provided for the negative etiology opinions submitted by the January 2021 examiner. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the January 2021 VA examiner or another examiner with similar and appropriate expertise. The examiner must be provided access to the claims file and a copy of this remand and must indicate a review of such in the examination report. 2. After a thorough review of the claims file, the examiner is asked to opine on the following: a) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's cervical spine disability was caused by or is otherwise etiologically related to service. In rendering this opinion, specifically address the Veteran's 1978 in-service diagnosis of cervical thoracic scoliosis and the Veteran's duties that included carrying heavy equipment and cooking supplies. b) Whether it is at least as likely as not (i.e. 50 percent or greater probability) that the Veteran's cervical spine disability is proximately due to or aggravated by the Veteran's service-connected lumbar spine disability. In rendering this opinion, specifically address studies and medical treatises that were noted by the Veteran's representative in an April 30, 2021, brief, which asserts that there may be a correlation between scoliosis and neck problems. The examiner should note that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. App. 74 (2018). As such, the examiner must provide separate findings and rationales relating to causation and aggravation. Further, aggravation under 38 C.F.R. § 3.310(b) does not require that there be "permanent" worsening of the nonservice connected disability. A complete rationale for any opinion must be provided. A complete rationale is one that contains not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. M. C. WILSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lee 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.