Citation Nr: 22015728 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 14-34 955 DATE: March 18, 2022 REMANDED Entitlement to service connection for a neck disability, to include degenerative changes of the cervical spine, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from April 1975 to April 1979 with additional service in the United States Army Reserves and the Massachusetts Air National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal of a rating decision issued by the U.S. Department of Veterans Affairs (VA) Regional Office (RO). In July 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A copy of the hearing transcript has been associated with the Veteran's electronic claims file. In a March 2020 decision, the Board denied the Veteran's claim. The Veteran appealed the Board's decision to the U.S. Court of Appeals for Veterans Claims (Court). In an October 2020 joint motion for remand (JMR), the parties (the VA Secretary and the Veteran) requested that the Board's decision be vacated, and the claim remanded. In an October 2020 Order, the Court granted the JMR, and the Veteran's claim was returned to the Board for further appellate consideration. In April 2021 and October 2021, the Board remanded the Veteran's claim for additional development. Although further delay is regrettable, the Board finds that an additional remand is required before the Veteran's claim may be decided. In the October 2020 JMR, the parties noted that in its March 2020 decision, the Board had not addressed the Veteran's documented in-service injury when a chair fell and struck his head in October 1984. The Veteran's service treatment records (STRs) show he required stitches on his scalp due to this incident, but did not report neck pain at the time. The Veteran, however, has attributed his neck disability to this injury. Alternatively, he has attributed his neck condition to a March 2004 fall in which he slipped on black ice. In its April 2021 remand, the Board directed that a VA examination and opinion be obtained. The examiner was specifically directed to address the 1984 injury. Importantly, the Board requested the examination be performed by a "physician with expertise in musculoskeletal disabilities." In response to the remand, a medical opinion was provided in May 2021 by a general practice Nurse Practitioner. Because the opinion was not provided by a physician with expertise in musculoskeletal disabilities, the Board remanded the claim again in October 2021. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (a remand by the Board confers on the Veteran, as a matter of law, a right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand). This time, the Board requested that the opinion be provided by a "qualified clinician who has expertise in musculoskeletal disabilities." In addition to the in-service incidents identified by the Veteran, the Board requested that the examiner address whether the Veteran's neck disability was causally related to his service-connected knee and/or hip disabilities. A medical opinion was obtained in December 2021. Unfortunately, upon review, the examiner who provided the opinion is a physician specializing in gynecology and obstetrics. There is no indication in the record that the examiner possesses special expertise in musculoskeletal disabilities. In addition, while the examiner addressed the in-service injuries referenced by the Veteran, he provided no opinion as to whether the Veteran's neck condition is causally related to his service-connected disabilities, as directed by the Board. For these reasons, the Board finds that substantial compliance with the previous remand directives had not been accomplished. As such, a remand for an additional medical opinion is warranted. The matter is REMANDED for the following action: Forward the Veteran's claims file to an orthopedist for a medical opinion as to the nature and etiology of the Veteran's neck disability. If the examiner determines that an additional examination is necessary, schedule the examination. After a review of the relevant records and lay statements, and an additional examination if indicated, the examiner should provide the following opinions: a) Whether the evidence is at least in approximate balance as to whether the Veteran's neck disability originated during or is otherwise etiologically related to his active service. In providing his or her opinion, the examiner must address the following: i) The Veteran's assertion that he has experienced neck pain ever since his documented in-service injury in October 1984 when a chair fell on his head, requiring stitches; and ii) The Veteran's assertion that he has experienced intermittent neck pain since his documented in-service fall on black ice in March 2004. b) Whether the evidence is at least in approximate balance as to whether the Veteran's neck disability is proximately due to or has been aggravated (worsened beyond its natural progression) by his service-connected right and/or left knee disabilities. c) Whether the evidence is at least in approximate balance as to whether the Veteran's neck disability is proximately due to or has been aggravated (worsened beyond its natural progression) by his service-connected right and/or left hip disabilities. The examiner must provide a full medical rationale for any proffered opinion. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Hampton, 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.