Citation Nr: 22016512 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 17-40 029 DATE: March 22, 2022 REMANDED Entitlement to service connection for a thoracolumbar disability is remanded. Entitlement to a cervical spine disability is remanded. Entitlement to carpal tunnel syndrome in the left upper extremity is remanded. Entitlement to carpal tunnel syndrome in the right upper extremity is remanded. REASONS FOR REMAND The appellant served on active duty in the United States Marine Corps from October 18, 1979, to November 9, 1979. This case comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) which, in pertinent part, denied the claims for service connection. This decision was appealed in a notice of disagreement (NOD) received by VA in December 2015. A Statement of the Case (SOC) was issued by VA in July 2017. VA received the appellant's Substantive Appeal (Form 9) requesting a hearing before a member of the Board in July 2017, perfecting the appeal. The appellant appeared before the undersigned Veterans Law Judge at a hearing on these issues in November 2021. A transcript of that hearing has been added to the record on appeal. As a preliminary matter, the appellant and his representative are here notified that no determinations regarding the appellant's credibility are being made in this remand. The Board has used the appellant's lay statements and assertions only for the purpose of obtaining an adequate VA examination and medical opinion. The inclusion of these assertions in the decision below should not be considered as a positive finding regarding the credibility of any of the appellant's statements. Should this claim be returned to the Board later, the Board will make credibility determinations as necessary at that time. 1. Entitlement to service connection for a thoracolumbar disability is remanded. The appellant contends that his scoliosis was aggravated beyond its natural progress by his period of active service with the United States Marine Corps. He asserts that after about a week of basic training, he reported to sick call with back pain which was attributed to scoliosis of his thoracic spine. Service treatment records are relatively consistent with this timeline and the diagnosis made. Although scoliosis was not noted on his October 1979 enlistment examination, the appellant was subsequently discharged honorably after a Medical Board found that he did not meet the enlistment criteria due to his scoliosis, which was determined to have existed prior to service and was not aggravated by service. After a review of the evidence of record, the Board finds that remand is necessary prior to the adjudication of this claim. As an initial matter, the Board notes that at the appellant's November 2021 hearing before the undersigned Veterans Law Judge, he indicated that he had been receiving Social Security disability benefits since around 2015. As these are Federal records, the Board finds that remand is necessary to allow VA an opportunity to obtain and consider these records prior to the adjudication of this claim. Turning to the medical opinions of record, the Board notes that the initial VA medical opinion from May 2014 is wholly inadequate, as it does not apply the right standard of review or answer the pertinent questions on appeal. The June 2017 VA medical opinion is also inadequate, as the examiner did not provide a sufficient rationale in support of the provided opinion. The examiner failed to indicate what evidence showed that there was a lack of aggravation of the appellant's scoliosis during active service. Additionally, the examiner provided insufficient explanation for the statement that the current cervical and thoracic spondylosis are not related to scoliosis. Considering the lack of rationale, the Board finds that the opinion is inadequate. See Nieves - Rodriguez v. Peake, 22 Vet. App. 295 (U.S. 2008) (explaining that most of the probative value of a medical opinion comes from its reasoning). The appellant also submitted a private medical opinion in April 2019 which stated that the appellant's pre-existing lumbar scoliosis and compensatory thoracic scoliosis were most likely aggravated by the physical demands of the appellant's military service. However, the opining clinician provided no explanation for this conclusory statement. The opining clinician did not explain how the underlying scoliosis was aggravated beyond its natural progression by such a short period of active service. The opining clinician also did not provide any opinion as to what link there was between the appellant's scoliosis and his cervical and thoracic spondylosis. As such, the Board finds the opinion inadequate. See Nieves - Rodriguez v. Peake, 22 Vet. App. 295 (U.S. 2008) (explaining that most of the probative value of a medical opinion comes from its reasoning). As there is no medical opinion of record addressing whether the appellant's scoliosis was aggravated beyond its normal progression by his period of active service, the Board finds that remand is necessary to obtain a new medical opinion addressing this issue. 2. Entitlement to a cervical spine disability is remanded. 3. Entitlement to carpal tunnel syndrome in the left upper extremity is remanded. 4. Entitlement to carpal tunnel syndrome in the right upper extremity is remanded. The appellant has asserted that his in-service diagnosis of scoliosis and the asserted aggravation beyond its natural progression of that scoliosis is approximately as likely as not the cause of the appellant's diagnosed degenerative disc disease and spondylosis of the cervical spine. Additionally, he contends that this cervical spine disability is approximately as likely as not the cause of his bilateral carpal tunnel syndrome. As the above, underlying claim for service connection for a thoracolumbar disability is being remanded for further development, the Board finds that these claims should also be remanded. The Board finds that the question of whether these disabilities are secondary to a service-connected disability is inextricably intertwined with the question of whether entitlement to service connection for the thoracolumbar disability is warranted. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (holding that where a decision on one issue would have a significant impact upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). As such, the Board orders that these issues be remanded and re-adjudicated following the above ordered development related to the service connection claim for a thoracolumbar disability. Should additional development show that the appellant's thoracolumbar disability warrants service connection, then additional VA medical opinions should be obtained addressing whether the claimed cervical spine and carpal tunnel disabilities are approximately as likely as not related to any thoracolumbar disability which is found to warrant service connection. The matters are REMANDED for the following action: 1. Obtain the appellant's records from the Social Security Administration. Document all requests for information as well as all responses in the claims file. 2. Schedule the appellant for a VA examination for his claimed thoracolumbar disability. After examining the appellant and reviewing the record, the examiner should delineate all current thoracolumbar spine disabilities, to include scoliosis and/or spondylosis. The examiner should then provide a response to the following: Did scoliosis clearly and unmistakably (undebatable) preexist the appellant's service? Why or why not? If the examiner finds scoliosis did clearly and unmistakably preexist service, was it clearly and unmistakably not aggravated by service? Why or why not? Aggravation is a permanent worsening beyond the natural progress. If the examiner finds that scoliosis did not clearly and unmistakably preexist service or did but was aggravated beyond its normal progression by active service, the examiner must opine as to whether any other current thoracolumbar disability, to include spondylosis, or any cervical disability, to include spondylosis, is causally related to the in-service scoliosis or aggravation of scoliosis, or to another in-service disease or injury. In providing the requested opinion, the examiner should consider the appellant's description of his 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 appellant's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the appellant's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the appellant's reports generally inconsistent with medical knowledge or implausible? 3. If the examiner finds that any thoracolumbar disability is related to active service, the examiner should answer the following: Are any current cervical spine disabilities or bilateral carpal tunnel syndrome approximately as likely as not proximately due to a service-connected thoracolumbar disability? Is any current cervical disability or bilateral carpal tunnel syndrome approximately as likely as not aggravated by a service-connected thoracolumbar disability? K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kleponis, 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.