Citation Nr: 21040573 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 17-04 349 DATE: July 6, 2021 REMANDED Service connection for lumbosacral spine disability. Service connection for cervical spine disability. REASONS FOR REMAND The Veteran served on active duty from July 1978 to June 1984, August 1984 to July 1992, and May 2005 to November 2006, to include a period of active duty for training (ACDUTRA). The claim is on appeal from a December 2012 rating decision. In December 2020, the Veteran testified at a Board hearing. 1. Service connection for lumbosacral spine disability. 2. Service connection for cervical spine disability. The Veterans contends his lumbosacral and cervical spine disabilities were caused by service, or alternatively, caused or aggravated by his service-connected bilateral anterior cruciate ligament (ACL) reconstruction and/or the right distal fibula fracture. Service treatment records (STRs) provide that in June 1979, the Veteran was struck and dragged by a truck while riding a bicycle. His cervical spine was examined and found negative for injury at that time. Additionally, in October 1991, a spinal fracture was noted. Post-service medical records include a February 2012 note providing the Veteran experienced neck and back pain, the latter suggestive of osteoarthritis. In September 2012, there were mild degenerative disc changes at C6-C7 and C7-T1 of the cervical spine and mild and degenerative disc changes at L4-L5 and L5-S1 of lumbar spine. In October 2013, the Veteran complained of chronic and low back pain, worse with ambulation. In December 2013, physical therapy was recommended for degenerative changes of the cervical and lumbar spine. The Veteran was afforded a VA examination in September 2012. At that time, the examiner found the Veteran had no diagnosed neck condition. However, he did have degenerative disc disease of the cervical spine. The examiner concluded there was no connection between the Veteran's low back and neck pain and his service-connected knees or right ankle. Another VA examination was provided the Veteran in November 2016. The examiner concluded it was less likely as not that the Veteran's neck condition and lumbar DJD were aggravated beyond normal progression by his service-connected bilateral ACL reconstruction and/or the right distal fibula fracture. Additionally, combined residuals of his service-connected right distal fibula and bilateral ACL reconstruction have not caused excess mechanical stress on his cervical or lumbar spine. The November 2016 examiner did not consider the notations of spinal incidents from the STRs. Further, the examiner provided only a conclusory opinion as to the relationship between the Veteran's cervical and lumbar spine disabilities and his service-connected disabilities. As such, the rationale is insufficient. Accordingly, another VA medical opinion should be obtained. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician regarding the Veteran's lumbar and cervical spine disabilities. The need for an in-person diagnostic examination should be determined by the appointed examiner. (a.) The examiner must provide a diagnosis for any conditions found extent related to lumbar and/or cervical spine disabilities. In doing so, the examiner must conduct all necessary testing, unless it can be explained why such testing is not medically necessary. (b.) For each identified diagnosis, the examiner should provide an opinion as to: (1) whether it is at least as likely as not (i.e., at least equally probable) that the disability had its onset during, or is otherwise related to, the Veteran's service. (c.) The examiner should also specifically opine as to whether the Veteran's lumbar and/or cervical spine disabilities were caused or aggravated by his service-connected bilateral ACL reconstruction and/or right distal fibula fracture. (d.) The term "aggravation" means an increase in severity beyond the natural progress of the disease. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Becton, Associate 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.