Citation Nr: 22013652 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 14-11 929 DATE: March 10, 2022 REMANDED Entitlement to service connection for a disability of the cervical spine is remanded. REASONS FOR REMAND The Veteran served on active duty from May to September of 1974 with several additional periods of service in the Army Reserves. This matter initially came to the Board from a June 2012 decision of the Agency of Original Jurisdiction (AOJ). In January 2017, the Veteran testified before the undersigned at a videoconference hearing. A transcript of that hearing is of record. This appeal once included separate claims for service-connected compensation for a psychiatric disorder, for a disability manifested by headaches, and for a disability of the left wrist. The AOJ granted the psychiatric claim in March 2019 while the Board granted the headaches claim in February 2021 and denied the left wrist claim in August 2021. The claim for service connection for a cervical spine disability is now the only issue remaining in this appeal. The Board denied the cervical spine claim in February 2018 and, most recently, in February 2021. On both occasions, however, the Veteran appealed the unfavorable ruling to the United States Court of Appeals for Veterans Claims (Court) and, after further proceedings, the parties filed Joint Motions for Remand (JMR), in which they agreed that the Board erred by failing to give an adequate explanation for its denial of the cervical spine claim. The parties filed the most recent JMR in November 2021. By granting the November 2021 JMR, the Court vacated the February 2021 denial of service connection for a cervical spine disability and remanded that claim back to the Board. In its vacated February 2021 decision, the Board relied on a medical opinion prepared by a physician assistant who examined the Veteran's cervical spine in August 2020. As the Board explained, the August 2020 examiner considered and gave detailed comments about the Veteran's theory that her current disability of the cervical spine was caused or aggravated by a documented injury she sustained in November 1993, during a period of active duty for training (ACDUTRA). This injury, the examiner wrote, caused a scalp contusion which is "a separate entity entirely" from her cervical spondylosis or degenerative cervical arthritis. According to the examiner, the complaints of headaches and back pain recorded in 1994 and 1995 related to a "clearly pre-existing cervical spine condition (also described in June 1994) that had developed over a prolonged period of time." The Board accepted this opinion, in part because it was consistent with a letter prepared in June 1994 by a chiropractor who treated the Veteran's cervical spondylosis at that time. The November 2021 JMR does not criticize the August 2020 opinion or the February 2021 Board decision for their analysis of the November 1993 injury. The weakness of the February 2021 Board decision, according to the JMR, was its apparent failure to explain its rejection of a separate contention the Veteran's suggestion that her current cervical spine disability was caused or aggravated by her experience of wearing a Kevlar helmet during training exercises. Although the August 2020 medical opinion rejected this theory, the examiner did not support his unfavorable conclusion with the kind of detailed explanation with which he addressed the Veteran's separate contention concerning the possible effects of the November 1993 injury. Although the Board sincerely regrets the need for the need for further delay, it is necessary to remand the cervical spine claim for a new medical opinion. Because the JMR did not criticize the aspects of the August 2020 opinion or February 2021 Board decision addressing the significance of the November 1993 injury, the Veteran's contention about the potential effects of her use of the Kevlar helmet will be the main focus of the post-remand opinion. The matters are REMANDED for the following action: 1. Send the claims file to a qualified person or persons to obtain a medical opinion on the nature and etiology of the Veteran's current disability of the cervical spine, previously diagnosed and spondylosis and degenerative arthritis. If an in-person examination is needed before the examiner can prepare the requested opinion, then a new in-person examination should be arranged. After completing his or her review of the claims file and, if necessary, after examining the Veteran, the examiner should indicate whether it is at least as likely as not (50 percent probability or more) that any current disability of the cervical spine, including spondylosis and/or degenerative changes was caused or aggravated by the Veteran's wearing a Kevlar helmet during training exercises. The examiner should provide a complete rationale thoroughly explaining the medical reasons for his or her conclusion. If the examiner believes that the Veteran's wearing of a Kevlar helmet did not cause or aggravate her cervical spine disability, he or she should discuss a June 1994 treatment note indicating that she had been experiencing back pain "for several months" before that appointment and subsequent notes, in July 1994, September 1994, and February 1995, indicating similar complaints. The examiner should also discuss a June 1994 letter from a chiropractor which indicates that, in his opinion, the Veteran's cervical spondylosis was likely the result of "a long period of progressive deterioration rather than because of some progressive trauma." Could wearing a Kevlar helmet during multiple training exercises have caused or aggravated this progressive deterioration in her cervical spine? Why or why not? 2. The AOJ must ensure that the requested opinion complies with the directives of this remand. If any report is deficient in any manner, the AOJ must implement corrective procedures. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Nye, 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.