Citation Nr: 22005802 Decision Date: 02/02/22 Archive Date: 02/02/22 DOCKET NO. 16-61 640 DATE: February 2, 2022 REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1982 to July 1986. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. When this matter was previously before the Board in May 2020, the Board remanded for further development. The matter has now returned to the Board for appellate review. 1. Entitlement to service connection for a lumbar spine disability is remanded. 2. Entitlement to service connection for hypertension is remanded. The Board regrets any further delay in this matter, but finds additional development is required. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, the Veteran's case was remanded for medical opinions to assess the nature and etiology of his claimed lumbar spine disability and hypertension. In the May 2020 Remand, the Board noted, as it relates to the claimed lumbar spine disability, that the May 2013 VA examiner did not discuss the Veteran's lay statements in the context of the negative opinion. Accordingly, the appropriate remedy was to obtain an addendum medical opinion that considers the Veteran's lay statements, including his contentions regarding ongoing back pain both during and after service. As part of the specific remand directives, the Board instructed the examiner to consider the Veteran's competent and credible statements regarding continuous back pain from service to the present. In that same Remand, the Board noted, as it relates to the claimed hypertension, that the Veteran had not been afforded a VA examination. As part of the specific remand directives, the Board instructed the examiner again to consider the Veteran's lay statements regarding the onset of hypertension and his contention that the disability may be related to his acknowledged exposure to contaminated water at Camp Lejeune. New medical opinions were obtained in May 2021 and October 2021. However, none of the medical opinions addressed the Veteran's lay statements concerning his credible statements of continuing symptomatology since service. Instead, for the claimed back disability, the examiner focused solely on the Veteran's exit exam not mentioning a history of back condition and the earliest record of treatment for post-service back pain in December 2004, roughly 18 years after service. For the claimed hypertension, the examiner focused on the service treatment records lacking a diagnosis or treatment for hypertension, and the Veteran's known risk factors. The examiner did not offer a sufficient rationale for the opinion that the Veteran's hypertension is not likely due to contaminated water exposure at Camp Lejeune, stating instead only that hypertension is not presumed to be related to such exposure and that the Veteran's file does not contain evidence to support such a finding. The Board finds this conclusion to be unsupported by actual rationale or discussion of the evidence apparently relied upon. A remand by the Board confers on the claimant a legal right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). A failure by the Board to ensure that its remand orders are complied with constitutes legal error. Id. On remand, new medical opinions that address all of the Board's remand directives must be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a qualified clinician to determine the nature and etiology of the Veteran's lumbar spine disability. The Veteran's claims file, including a copy of this remand, must be made available to and reviewed by the examiner. The examiner must provide a well-reasoned opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any currently diagnosed lower back disorder began during service, within one year of service separation, or is otherwise etiologically related to service. The examiner is advised that the Veteran is competent to report history and symptoms, including his credible reports of back pain during service and continuing thereafter. The examiner must specifically and comprehensively discuss the Veteran's competent and credible reports regarding his continuous back pain from service to the present. The examiner is also reminded that a lack of treatment is not itself a sufficient reason to find a disability is not related to service. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A thorough rationale is required for adjudication. 2. Obtain an addendum opinion from a qualified clinician to determine the nature and etiology of the Veteran's hypertension. The Veteran's claims file, including a copy of this remand, must be made available to and reviewed by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension began in service, within one year of service separation, or is otherwise related to the Veteran's service, to include his acknowledged exposure to contaminated water at Camp Lejeune. In providing this opinion, the examiner must consider and address the Veteran's lay statements concerning the onset of his symptomatology. The examiner must specifically and thoroughly discuss the Veteran's contention that his hypertension may be related to exposure to contaminated water at Camp Lejeune. The examiner must provide a well-reasoned opinion as to whether the Veteran's hypertension has been: a) Caused by his low back disorder, to include any treatments therefor, or b) Aggravated by his low back disorder, to include any treatments therefor. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A thorough rationale is required for adjudication. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jiggetts, T. 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.