Citation Nr: 21042632 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-05 586 DATE: July 13, 2021 REMANDED Entitlement to service connection for cervical spine degenerative disc disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from May 1967 to February 1969. This matter comes before the Board of Veterans Appeals (Board) on appeal from a January 2013 decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded in February 2019, to obtain a new VA medical opinion on the etiology of the Veteran's cervical spine degenerative disc disease. When a case is remanded, a veteran is entitled to substantial compliance with all remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). If the RO does not substantially comply with the Board's remand instructions, the Board is legally bound to continue remanding until the mistake is corrected. See id. Additionally, VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The Board finds that the August 2020 VA opinion regarding the etiology of the Veteran's cervical spine degenerative disc disease gave an inadequate rationale, and a new examination is therefore necessary. The August 2020 examiner found that the Veteran's cervical spine degenerative disc disease was less likely than not caused or aggravated by his service-connected neck injury. The bulk of this opinion was based on a finding that, when the Veteran was struck by shrapnel in the neck during service, his "injuries were to the soft tissues, the right common carotid artery, and the vagus nerve only." However, the Veteran is not arguing that his degenerative disc disease was directly caused by being struck by shrapnel; rather, he claims to have been told by medical providers that his soft-tissue neck injuries contributed to muscle cramping in the neck and a tendency to lean his neck to the side, which in turn caused or aggravated his degenerative disc disease. The examiner also concluded that there was no aggravation of the Veteran's degenerative disc disease because "review of the available records yields no evidence that there has been any significant change in the veteran's condition since [2012]." The examiner does not explain how a lack of significant progression between 2012 and now is evidence that the Veteran's degenerative disc disease was not aggravated by a condition he had prior to 2012. The Board notes that both the August 2020 VA examination and the prior, October 2012 VA examination of the Veteran's cervical spine were conducted by the same examiner. On remand, the RO should obtain the required medical opinion from a different clinician, if possible. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate physician, who has not previously provided an opinion in this case, regarding the nature and etiology of the Veteran's cervical spine degenerative disc disease. If the examiner believes an in-person or telehealth examination is necessary, one should be scheduled. After reviewing the entire claims file, the examiner should answer the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's cervical spine degenerative disc disease was caused or aggravated by an in-service event, injury, or disease? (b) Is it at least as likely as not that the Veteran's cervical spine degenerative disc disease was caused by his service-connected neck injury, including as a result of muscle spasms or changes in posture caused by his neck injury and associated surgeries? (c) Is it at least as likely as not that the Veteran's cervical spine degenerative disc disease was aggravated by his service-connected neck injury, including aggravation due to muscle spasms or changes in posture caused by his neck injury and associated surgeries? (d) If the Veteran's cervical spine degenerative disc disease is unrelated to his military service, what is its likely etiology? A complete and fully explanatory rationale must be provided for any opinion offered, citing any record evidence or medical literature relied upon. If an opinion cannot be rendered without resorting to speculation, the examiner must explain why. Signature on next page DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shermila Sundquist 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.