Citation Nr: 22012272 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 17-64 402 DATE: March 3, 2022 REMANDED Entitlement to service connection for a neck condition is remanded. Entitlement to service connection for a back condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the Air Force from July 1983 to March 1992. In November 2019, the Veteran testified at a videoconference hearing before the undersigned, and a transcript of that hearing is of record. The Board remanded the issues in October 2021 for further development, including obtaining VA medical opinions on the etiology of the neck and back conditions. Subsequently, VA medical opinions on the etiology of the neck and back conditions were obtained in November 2021. However, as set forth more fully below, because the November 2021 VA medical opinions lack the necessary adequacy for adjudication, substantial compliance with the Board's October 2021 remand directives has not yet occurred; accordingly, the Veteran's claims for service connection for neck and back disabilities must unfortunately be remanded again for further development. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for neck and back disabilities. Unfortunately, another remand is required in this case. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. As an initial matter, the Board notes that a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In November 2021, the Veteran was provided VA neck and back medical opinions. The VA examiner opined that both the Veteran's neck and back conditions were less likely than not related to active military service, to include due to the in-service motor vehicle accident. The rationale provided indicated that although it is documented that he attained a contusion to his forehead, there are no other complaints or signs and symptoms that Veteran injured his neck or back during service or as a result of the 1985 accident in Italy. Additionally, the VA examiner stated that there is documentation in the records that the Veteran injured his back due to heavy lifting and the process of senescence is more likely than not that etiology of his back pain. The Board notes that in February 2022, the Veteran's representative submitted a correspondence letter indicating that the November 2021 VA medical opinions are inadequate and cannot be relied on to deny the Veteran's neck and back claims. First, the representative asserted that the VA examiner was a doctor in internal medicine and presented no qualifications in musculoskeletal examinations. Second, the Veteran's representative indicated that the VA examiner's conclusions for the neck and back etiology's were not supported by the evidence and a proper rationale was not provided. The representative claimed that the rationale for the neck and back opinions were similar and not unique to the specific disabilities. Further, the representative asserted that the VA examiner discounted the forehead contusion as evidence of injury to the Veteran's neck and back and also discounted how a head injury suffered during a motor vehicle accident was not evidence of impact to the neck and back. The representative also claimed that service treatment records (STRs) from June 1988 show numbness in the thigh which could be related to a back or neck issue. Next, the representative noted that the VA examiner believed that heavy lifting was the cause of the Veteran's current neck and back issues. However, the representative notes that the Veteran contends that his duties as an aircraft support equipment mechanic required him to pull heavy equipment impacting his musculoskeletal system, causing injury to his neck and back. The VA examiner did not comment of whether the Veteran's heavy lifting during service could have caused his current neck and back pain. In light of these arguments, the Board finds that another remand is necessary to provide the Veteran with an addendum medical opinion accompanied with a complete and proper rationale. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision"). Although the Board regrets this delay, such a remand is necessary to ensure fair and appropriate adjudication of the Veteran's claim consistent with VA's duties to assist. The matters are REMANDED for the following action: Obtain an addendum opinion from a qualified clinician, who has expertise in musculoskeletal disabilities, to determine the current etiology of the Veteran's neck and back disabilities. The Veteran should receive another in-person VA examination if the clinician deems it to be necessary. The examiner must provide a complete written history, including all statements and reports made by the Veteran as to his military service. The VA examiner should offer the following opinions: Is it at least as likely as not (50 percent or greater probability) that any diagnosis relevant to the claimed neck and/or back condition had its origin during, or is in some way the result of, the Veteran's periods of active military service, to include due to the in-service motor vehicle accident. In rendering the following two medical opinions for the Veteran's neck and back disabilities, the examiner MUST discuss and comment on the Correspondence Letter from the Veteran's representative, dated on February 16, 2022, and address the following as part of their rationale: Whether the Veteran's head injury, that was noted during the motor vehicle accident, had any impact on the Veteran's neck and/or back disabilities; Whether the June 1988 STR note that the Veteran had numbness in his thigh, could be related to the Veteran's neck and/or back pain suffered during service; and Whether the Veteran duties as an aircraft support equipment mechanic, which required him to pull heavy equipment, had any impact on his musculoskeletal system, causing injury to his neck and back. (Continued on the next page) A thorough rationale should be provided for all opinions expressed, including discussion of the facts of this case and any medical studies or literature relied upon. The examiner should fully articulate a sound reasoning for all conclusions made. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Dourmashkin 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.