Citation Nr: 21042265 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 14-25 029 DATE: July 12, 2021 REMANDED Entitlement to service connection for a low back disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1989 to July 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2009 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). In a February 2021, the Board remanded this matter to ensure substantial compliance with the March 2020 remand directives. Specifically, the Board found that the February 2021 VA examiner's opinion did not consider the Veteran's in-service treatment for low back pain. See BVA Decision received 2/24/2021 at page 10. Although the Board regrets the delay, it must once again remand this claim for a new medical opinion and VA examination. Entitlement to service connection for a low back disorder is remanded. The Veteran contends that his low back pain began during his active duty service when he picked up a box of milk while on the ship. See C&P Exam received 8/27/2020 at page 3. The Veteran reports that since service his lower back pain has progressed and worsened. Id. The Board finds that another remand is warranted because there has not been substantial compliance with the prior remand directives. Stegall v. West,11 Vet. App. 268, 271(1998) (holding that there must be substantial compliance with the terms of a Court or Board remand). In the February 2021 Board decision, the Board directed that the VA examiner "consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted." See BVA Decision received 2/24/2021 at page 10-11. However, in the addendum opinion, the VA examiner stated " there is no medical report to support continuity of care from 1991 up until 2009 when the X-rays of the lumbar spine done on 3/09/09". The VA examiner based the negative opinion on the lack of medical records and did not consider the Veteran's lay statements of continuity of symptomatology. Therefore, the February 2021 VA examiner did not substantially comply with the remand directives that expressly directed that the Veteran's lay statements be considered in the opinion. Given the lack of compliance with the remand directives, the Board will order that the Veteran receive a new VA examination and medical opinion from a different VA clinician. This matter is REMANDED for the following action: Schedule the Veteran for a VA examination for his low back disorder with a different clinician than the March 2021 VA examiner. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: (a) Is the Veteran's low back disorder at least as likely as not (probability of approximately 50 percent) related to service, including in service treatment for lower back pain? See STR received 8/07/2014 at pages 72, 78, 81, 86, 89, 100 and 102. **In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?** (b) Is it at least as likely as not (probability of approximately 50 percent) that the Veteran's low back disorder with degenerative changes at L5-Sl (1) began during active service, (2) manifested within presumptive period after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? (Continued on the next page) The examiner must provide a complete rationale for his or her opinions in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Dixon, 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.