Citation Nr: 21041727 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 15-17 717 DATE: July 10, 2021 REMANDED Entitlement to service connection for a lumbar spine disorder is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the United States Navy from March 1972 to December 1973, with subsequent Reserve service. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Veteran testified before the undersigned and the Board remanded the claim in June 2019. The Board regrets the delay, but remand is necessary to obtain records from the United States Railroad Retirement Board, as they may have relevant information in relation to the Veteran's 1991 back injury. Additionally, the issue of entitlement to secondary service connection based on gait changes from the Veteran's service-connected left ankle disability has been raised by the Veteran's representative post remand and must be addressed in an addendum opinion. See June 2021 Written Brief Presentation. Moreover, one last attempt for complete STRs should be made. See id. This issue is REMANDED for the following action: 1. Obtain the Veteran's complete STRs, and notify the Veteran of any inability to obtain the same. Please note that the Veteran was with the Naval Reserve until 1977. 2. Obtain any outstanding VA treatment records. Notify the Veteran of any inability to obtain the same. 3. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. Notify the Veteran of any inability to obtain the same. 4. With any necessary assistance from the Veteran, obtain any records held by the Railroad Retirement Board in connection with his medical retirement in 1991. Notify the Veteran of any inability to obtain the same. 5. Then obtain an addendum opinion from an examiner other than the December 2019 VA examiner to determine the etiology of the Veteran's current back disability. The claims file, including a copy of this remand, must be provided to the examiner in conjunction with the requested opinion. The examiner is asked to address the following: (a.) For diagnosed lumbosacral strain and degenerative arthritis of the spine, please opine as to whether it is at least as likely as not (50 percent probability or higher) that the each disability had its onset in or is otherwise related to active service, to include as a result of the cumulative impact of daily and prolonged strenuous physical activities associated with his military occupational specialty (MOS) of ammunitions loader (carrying heavy equipment, constant bending twisting, up and down movements, etc.). In addressing this question, the examiner must discuss: (1) the Veteran's report that his back pain started in service as a result of his MOS and has gotten progressively worse over time (See December 2010 Correspondence; October 2018 Board Hearing Transcript); (2) the Veteran's statement that although his back problems had their onset in service, they did not happen overnight (See November 2012 Notice of Disagreement (NOD); October 2018 Board Hearing Transcript at 6-7); (3) the Veteran's statement that he had no idea of the long-term effects that his MOS duties would have on his back (See May 2015 VA Form 9); (4) the Veteran's MOS (ammunitions loader) where he worked as a part of the deck crew to load and unload bombs for use and that he injured his back due to repeated use and grueling hours over the course of his 2 years (See May 2003 VA 21-526; May 2015 VA Form 9; October 2018 Board Hearing Transcript at 2-4); (5) the Veteran's statement that his MOS was a 24-hour a day 7 days a week job, which included constant bending, twisting, up and down movements, incorporating a lot of movement, and loading the ammunition consisting of running cable through a palletized load, stooping down to do so, and bending and twisting, placing the cable on the hook, noting the bombs weight of hundreds of pounds (See December 2010 Correspondence; November 2012 NOD; May 2015 VA Form 9); (6) the Veteran's statement that there was no safety equipment or back stabilization apparatus offered or available for any of the deck force (See March 2011 Correspondence; October 2018 Board Hearing Transcript at 4); (7) the Veteran's statement that after service he took a desk job, with no manual labor, because he knew his back could not handle any more physical labor (See October 2018 Board Hearing Transcript at 6); (8) the Veteran's testimony that in 1991 he was walking down the hallway and his legs gave out and he fell and he could not get back up, noting a sharp pain in his back, and that this event triggered him to start seeking medical help after all of the years that had passed (See October 2018 Board Hearing Transcript at 7); (9) the 2002 private treatment record showing the Veteran's inability to use free weights due to back pain; (10) the statements from friends and family of the Veteran, including from his nurse sister, who have observed a significant decline in his back over the years and that he cannot do things that he used to be able to do due to debilitating pain (See October 2018 Statements from D.B. and K.C.; June 2019 Statement from J.M. and K.C.) and determine, based on the same, whether a nexus between the Veteran's back disability and service is "medically plausible," despite the absence of objective documentation. (b.) Please also opine as to whether it is at least as likely as not (50 percent probability or more) each disability is (1) proximately due to or (2) aggravated (worsened) by his service-connected left ankle disability, to include as the result of his antalgic gait as documented in his VA treatment records See June 2010 and May 2012 VA treatment record (noting an antalgic gait). Please provide two separate opinions, and please discuss the supportive literature cited by the Veteran's representative in the June 2021 brief. Please note that there is no temporal requirement that the primary condition (left ankle disability) be service-connected, or even diagnosed, at the time the secondary condition (back disability) is incurred, and reliance on this fact will render any opinion inadequate. In rendering opinions, the Veteran's statements may not be discounted solely on the lack of confirmation in the medical records. Please be advised any negative opinion premised solely on an absence of treatment will be returned as inadequate. If the Veteran's reported history is discounted, the examiner must provide a reason for doing so. If unable to provide an opinion, please indicate whether there is any additional evidence that would enable you to do so, or whether the inability to opine is based on the limits of medical knowledge. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. J. Rogers, 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.