Citation Nr: 21032428 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 17-10 353 DATE: May 27, 2021 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for an acquired psychiatric disorder, claimed as major depressive disorder (MDD), is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1967 to November 1974. In February 2020, the Board of Veterans' Appeals (Board) remanded the claim to the Agency of Original Jurisdiction (AOJ) of the Department of Veterans Affairs (VA) for additional development. The case has since been returned to the Board for appellate review. 1. Entitlement to service connection for a low back disability is remanded The Veteran contends that he has had back pain since his active duty service. In October 2020, a VA examiner opined that the claimed condition was less likely than not incurred in or cause by the claimed in-service injury, event, or illness. The examiner explained that the STRs showed no evidence of an injury to the Veteran's back, nor is there evidence that the back condition was reported or assessed within one year of discharge. During the examination, the Veteran reported having back pain due to pushing and pulling of objects with treatment being pain medication and rest. He reported that his back pain had worsened since onset, yet the examiner found that the progressive clinical record did not verify this progression. Notably, there was a gap of over 10 years from discharge to his first report, and treatment of, back pain. Also, the examiner noted that the Veteran had been diagnosed with morbid obesity since his separation from active service. However, the Board notes that a lack of treatment is an inadequate basis for a negative etiology opinion as the Veteran explained at his December 2019 Board hearing that he did not have medical insurance after his active service and was unable to pay a physician for treatment of his low back pain. Also, the October 2020 VA examiner reasoned that the Veteran's morbid obesity was a cause of his low back pain; however, the examiner did not note the onset of the obesity or if it was documented in the record from the beginning of the Veteran's back complaints. Therefore, in light of the foregoing, the Board finds that additional medical opinion is in order. 2. Entitlement to service connection for a neck disability, a bilateral hip disability, and an acquired psychiatric disorder is remanded. The Veteran claims that his neck disability, bilateral hip disability, and acquired psychiatric disorder are secondary to his lower back disability. The Veteran does not contend, and the record does not reflect, that the Veteran's neck disability, bilateral hip disability, and acquired psychiatric disorder had their onset in service, or that the disabilities are otherwise directly related to the Veteran's military service. Thus, the issue of secondary service connection for a neck disability, bilateral hip disability, and acquired psychiatric disorder disability is inextricably intertwined with the issue of service connection for a low back disability. If service connection is established for a low back disability on remand, the AOJ should ensure that adequate VA medical opinions are of record that address the Veteran's claim of secondary service connection. The matters are REMANDED for the following action: 1. Obtain a VA supplemental medical opinion by an appropriate clinician to determine the nature and etiology of any current back condition. The record must be made available to the examiner and the examiner should indicate in his/her report whether the record was reviewed. Based on a review of the record and any examination findings, if conducted, the examiner should address the following: (a.) Identify all current diagnoses of the back. (b.) As to each currently diagnosed back disorder, indicate whether it is at least as likely as not that the condition (1) began during active duty; (2) is otherwise related to any in-service event or injury on the basis of service incurrence or aggravation of a preexisting disorder; (3), for arthritis only, manifested within one year of active duty service. (c.) The examiner must review the October 2020 VA opinion attributing the Veteran's disability, in part, to obesity, and address whether the record supports the Veteran's competent back pain complaints since active service being etiologically related to morbid obesity. The examiner should address the Veteran's contention that he has had back pain since his active service. Also, the examiner should note that lack of treatment records for back pain is not an adequate reason for a negative etiology opinion given the Veteran's reported lack of finances and medical insurance after active duty service. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner explain why an opinion cannot be provided and specifically state whether the inability to provide an opinion is due to the limits of the examiner's knowledge, the limits of medical knowledge in general; or there is additional evidence that would allow for an opinion on this matter. 2. Only if the Veteran's low back disability is deemed to be service connected, obtain appropriate supplemental medical opinions that adequately address the Veteran's claim of secondary service connection for a neck disorder, bilateral hip disorders and an acquired psychiatric disorder. The record must be made available to the examiner and the examiner should indicate in his/her report whether the record was reviewed. Based on a review of the record and any examination findings, the examiner(s) should address the following: As to the Veteran's neck disorder (to include cervical neck strain), bilateral hip disorders (to include hip strain with degenerative changes including S1 joint sclerosis), and acquired psychiatric disorder (to include unspecified depressive disorder), indicate whether it is at least as likely as not that the condition (1) is proximately due to, or aggravated beyond the natural progression of the disorder, by the Veteran's back disability. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner explain why an opinion cannot be provided and specifically state whether the inability to provide an opinion is due to the limits of the examiner's knowledge, the limits of medical knowledge in general; or there is additional evidence that would allow for an opinion on this matter. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Costello, 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.