Citation Nr: 22013902 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 16-06 927 DATE: March 10, 2022 REMANDED Entitlement to service connection for lumbosacral strain is remanded. Entitlement to special monthly compensation due to housebound status is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 1981 to December 1981. This matter comes to the Board of Veterans' Appeals (Board) on appeal of a VA RO rating decision. In July 2019, the Veteran testified in a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is included in the electronic record and has been reviewed. This case was previously before the Board, most recently in May 2021, when remanded for further development. 1. Entitlement to service connection for lumbosacral strain is remanded. The Board cannot make a fully informed decision on the issue of entitlement to service connection for lumbosacral strain because no VA examiner has provided an adequate medical opinion whether the Veteran has a current back disability that began during active service. As a general matter, once VA undertakes to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In November 2021, the Veteran underwent a VA examination. The VA examiner noted the Veteran's medical history of a 1981 injury "playing football and twisted back during tech school" and diagnosed degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome, and lumbosacral strain. In the examination report, the boxes were checked indicating both that the degenerative disc disease, degenerative arthritis, bilateral lower extremity radiculopathy was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service football injury and that the lumbosacral strain was at least as likely as not (50 percent or greater probability) incurred in or caused by the claimed in-service football injury. An addendum VA medical opinion for clarification of the VA examination report is warranted. 2. Entitlement to special monthly compensation due to housebound status is remanded. Finally, because a decision on the issue of entitlement to service connection for lumbosacral strain could significantly impact a decision on the issue of entitlement to special monthly compensation due to housebound status, the issues are inextricably intertwined. A remand of the claims for entitlement to special monthly compensation due to housebound status is required. The matters are REMANDED for the following actions: In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 1. Return the claims file to the examiner who conducted the November 2021 VA examination and request they prepare an addendum which addresses the questions below. If the examiner is unavailable, arrange to have the questions answered by a suitably qualified health care professional. Only schedule the Veteran for another examination if the examiner determines it is required to answer the questions presented. The examiner is asked to provide a response to the following: (a.) Is the current back disorder at least as likely as not related to service, including a football injury? (b.) Did the current back disorder clearly and unmistakably (undebatable) preexist the Veteran's service? (c.) If the examiner finds it did clearly and unmistakably preexist service, was it clearly and unmistakably not aggravated by service? (d.) If the examiner finds that it either did not clearly and unmistakably preexist service, or was not clearly and unmistakably aggravated by service, the examiner must opine whether it is at least as likely as not related to service, including a football injury. (e.) Did the Veteran's the current back disorder, if it existed prior to service, at least as likely as not increase in severity during service? (f.) If so, was the increase in severity clearly and unmistakably (undebatable) due to the natural progress of the disease? Provide a rationale to support the opinions. The examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, medical literature, etc., relied upon in reaching the conclusions. If the medical professional cannot provide an opinion without resorting to mere speculation, the medical professional shall explain why. In so doing, the medical professional shall explain whether additional information is needed, or that the limits of current medical knowledge have been exhausted. Consider the Veteran's description of in-service injury and symptoms as well as post-service symptoms. Stated another way, do the Veteran's reports about 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? The Veteran is competent to report symptoms, including symptoms after separation from service and before any intervening injuries. The examiner must consider and discuss the November and December 1981 in-service complaints of back pain, the Veteran's lay statements and sworn testimony reporting constant pain since the in-service injury and the post-service 1986 workplace injury. The opinion and rationale must go beyond generalized statements that the evidence does not support the Veteran's claim. The rationale must reflect the specific facts and medical principles specific to the claim. If there is a medical basis to support or doubt the medical history provided by the Veteran, the examiner should so indicate and provide a fully reasoned explanation for this finding. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue of entitlement to special monthly compensation due to housebound status. If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James Hekel 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.