Citation Nr: 22016174 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 10-13 627 DATE: March 21, 2022 REMANDED Entitlement to service connection for a cervical strain, arthritis, intervertebral disc syndrome (IVDS) with radiculopathy of bilateral upper extremities, to include as secondary to hyperparathyroidism, and as due to an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) under 38 C.F.R. § 3.317 is remanded. Entitlement to service connection for a degenerative arthritis of the thoracolumbar spine, IVDS with radiculopathy of the right lower extremity, status post (SP) discectomy, to include as secondary to hyperparathyroidism, and as due to an undiagnosed illness or MUCMI under 38 C.F.R. § 3.317 is remanded. Entitlement to service connection for an acquired psychiatric disorder, claimed as posttraumatic stress disorder (PTSD), to include as secondary to hyperparathyroidism and fibromyalgia, is remanded. REASONS FOR REMAND The Veteran had active duty in the United State Marine Corps from December 1987 to August 1991, to include service in Southwest Asia from August 18, 1990, to March 23, 1991. In pertinent part, in February 2013 the Board of Veterans' Appeals (Board) denied service connection for a back disorder; and remanded a claim for service connection for a psychiatric disorder. The Veteran appealed the denial of the back disorder claim to the United States Court of Appeals for Veterans Claims (Court) and in an April 2014 Order vacated the Board's decision. The Veteran's claims subsequently have been remanded on one or more occasions, most recently in April 2020. As to the neck and back disability claims, a September 2020 rating decision granted service connection for osteoporosis of the cervical and thoracolumbar spine, as due to service-connected hyperparathyroidism, SP parathyroidectomy, and assigned an initial noncompensable disability rating effective August 1, 2011. In November 2020, the initial ratings were increased to 20 and 10 percent respectively. This was considered a partial grant. In February 2021, the Board denied the above claims. The Veteran appealed that determination to the Court and in a November 2021 Order, granted an October 2021 Joint Motion for Remand (JMR) and vacated the February 2021 Board's denial of the above claims and remanded the issues to the Board. 1. Entitlement to service connection for a cervical strain, arthritis, IVDS with radiculopathy of bilateral upper extremities, to include as secondary to hyperparathyroidism, and as due to an undiagnosed illness or MUCMI under 38 C.F.R. § 3.317 2. Entitlement to service connection for a degenerative arthritis of the thoracolumbar spine, IVDS with radiculopathy of the right lower extremity, SP discectomy, to include as secondary to hyperparathyroidism, and as due to an undiagnosed illness or MUCMI under 38 C.F.R. § 3.317 The October 2021 JMR concluded the April 2020 Board remand instructions were not fully complied with by the Agency of Original Jurisdiction (AOJ). Specifically, the April 2020 Board instructions directed that either an examination be conducted by an orthopedic spine surgeon or that an examination be conducted by an appropriate medical professional and a medical opinion obtained from an orthopedic spine surgeon. The subsequent cervical and thoracolumbar spine examinations in June 2020 and October 2020 were conducted by a nurse practitioner with no medical opinion by an orthopedic spine surgeon. In light of the October 2021 JMR directives, the Board concludes that a remand for a medical opinion by an orthopedic spine surgeon is necessary. 3. Entitlement to service connection for an acquired PTSD, to include as secondary to hyperparathyroidism and fibromyalgia, is remanded. The October 2021 JMR concluded that with the April 2020 Board remand instructions were not fully complied with by the AOJ. Specifically, the April 2020 Board remand concluded that a February 2018 medical addendum opinion did not comply with the Board's August 2017 remand in that the medical professional "simply repeated the findings from the Veteran's medical records and did not give a rationale." The subsequent May 2020, according to the October 2021 JMR, merely repeated the findings of the inadequate February 2018 medical opinion. Based on the conclusions of the October 2021 JMR, the Board concludes that a remand for an additional VA examination is necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an orthopedic spine surgeon (as directed by the October 2021 JMR) regarding whether the Veteran's cervical strain, arthritis, degenerative arthritis of the thoracolumbar spine, and IVDS with radiculopathy of bilateral upper extremities and right lower extremity is at least as likely as not (a) incurred in service, (b) otherwise caused by service, (c) caused by a service-connected disability (including hyperparathyroidism), OR (d) aggravated beyond its natural progression by a service-connected disability (including hyperparathyroidism). A complete rationale must be provided for the opinions offered. In that regard, the medical reasons for accepting or rejecting the Veteran's statements regarding a continuity of symptoms since service should be set forth in detail. 2. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any posttraumatic stress disorder (PTSD) or other acquired psychiatric disorder. If the Veteran is diagnosed with PTSD, the examiner must explain how the diagnostic criteria are met and opine whether it is at least as likely as not related to a verified in-service stressor. If the Veteran is diagnosed with a personality disorder and PTSD - The examiner must opine whether the PTSD was at least as likely as not superimposed on a personality disorder during active service and resulted in additional disability. (a) If any other acquired psychiatric disorders are diagnosed, the examiner must opine whether each diagnosed disorder is at least as likely as not incurred in service or otherwise was caused by service. (b) In addition, the examiner must opine as to whether it is at least as likely as not that any diagnosed acquired psychiatric disorder was proximately due to a service-connected disability? (c) Is any diagnosed acquired psychiatric disorder at least as likely as not aggravated, i.e., worsened beyond its natural progression, by a service-connected disability? Provide a rationale to support the opinion(s). In reaching the above conclusions, the examiner is directed that the opinion may not be based on a simple repetition of the findings of the Veteran's medical records. In providing the requested opinion, consider the Veteran's description of his/her in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran's reports about his 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? J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Houbeck, 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.