Citation Nr: 22018113 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-57 027 DATE: March 28, 2022 REMANDED The appeal for service connection for a lumbar spine disorder is remanded. REASONS FOR REMAND The Veteran had active service from September 1976 to September 1979, from February 1985 to March 1992, from March 2001 to October 2001, and from September 2010 to November 2011 as well as periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This appeal was previously remanded by the Board in July 2019. As discussed in the July 2019 Remand, the Veteran asserts that his back disorder is due to an injury that occurred during active training in March 2006 and that he was treated for low back pain during service in Iraq in September 2011. See October 2017 VA Form 9. The Veteran's service records also include an August 2016 line of duty determination noting a June 7, 2015, incident during a two week period of active duty and a diagnosis of bilateral sciatica. Treatment records at that time indicate that the Veteran had been experiencing chronic back pain prior to the two week duty period but that it had flared for several days during active duty. An associated X-ray dated in June 2015 indicated that the Veteran had degenerative joint disease of the lumbar spine. The Veteran was provided with a VA examination in December 2013, which as the Board explained in the July 2019 remand, was rendered prior to the August 2016 line of duty determination. The December 2013 VA examiner found it was less likely the Veteran's low back condition was due to service. The examiner explained that at that time, the Veteran's lumbar spine diagnosis was Schmorl's node with intervertebral disc syndrome (IVDS). The examiner explained that the Schmorl's nodes were a radiologic finding of little clinical significance and that there was no indication that the Veteran was ever evaluated or treated for IVDS while on active duty. The Board remanded the appeal in July 2019 to address the claim given the new evidence. The Veteran was provided with another VA examination in November 2019. Unfortunately, the November 2019 VA examiner did not address all of the pertinent evidence. In the November 2020 Informal Hearing Presentation, the Veteran's representative raised the issue that the November 2019 VA examination report is inadequate as the examiner did not address the earlier service treatment records which also noted back complaints. For the following reasons, the Board agrees and finds that a VA addendum opinion is required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate.) The November VA examiner noted the Veteran's diagnosis of lipomatosis and degenerative disc disease. The examiner addressed a September 2011 treatment record regarding back pain and noted that the Veteran's complaints at the time were consistent with a back strain due to lifting duffle bags. The examiner also explained that the incident in service was minor and not significant enough to cause progression of the arthritis. The examiner opined that the Veteran's current disability is at least as likely as not due to lipomatosis and not service. The examiner cited medical journal articles and reasoned that the medical literature did not indicate that trauma, mechanical pain or lifting was a cause for lipomatosis. In reaching this conclusion, the November 2019 VA examiner did not address the March 2006 service treatment record which documented a fall affecting the Veteran's back, among other body parts. Further, the Board notes that the November 2019 VA examiner did not explain why he reached the conclusion that the Veteran's degenerative disease was due to lipomatosis and not the events in service. Additionally, the Board finds that the VA examiner did not adequately address the X-ray evidence of degenerative joint disease of the lumbar spine. The June 2015 X-ray which revealed the degenerative disease was rendered during a two week period of active service. Thus, the question arises as to whether the Veteran's degenerative disease began during the two week period of service or preexisted the two week period of service. To date, none of the VA opinions have addressed the correct criteria for evaluation of whether there was clear and unmistakable evidence that the disorder preexisted service. Review of the service treatment records reveals a normal spine examination on the most recent Report of Medical Examination dated in February 2008. Thus, the Veteran was presumed to be in sound condition when he entered the two week period of active service in June 2015. For all of these reasons, a VA addendum opinion is required to address whether any current lumbar spine disability is related to service. While on remand, any outstanding VA treatment records should also be obtained. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated from July 2018. 2. Following completion of item 1, obtain a VA addendum opinion to address the nature and etiology of the Veteran's low back disorder. The Board leaves it to the discretion of the clinician selected to render the opinion to determine whether the Veteran should be physically examined. The examiner is asked to answer the following questions: (a.) Identify all pertinent lumbar spine disorders. Consider the June 2015 X-ray which noted degenerative joint disease of the lumbar spine. (b.) For each disorder identified, is it at least as likely as not (a 50 percent probability or higher) that the disorder had its onset in service, during his first post-service year, or is otherwise related to service? Consider and address the Veteran's March 2006 fall in service, as well as treatment for back pain associated with heavy lifting in September 2011, and back pain with X-ray evidence of degenerative disease in June 2015. (c.) If the examiner finds that the disorder preexisted the June 2015 period of service and is not directly due to earlier periods of service, the examiner must address whether the disorder clearly and unmistakably preexisted the Veteran's active duty military service in June 2015? If so, identify the clear and unmistakable evidence. Also note the May 2002 Report of Medical Examination which indicated a normal spine examination. (Continued on the next page) (d.) If the answer to question (c) is "yes" is there also clear and unmistakable evidence that the disorder was NOT permanently aggravated beyond its natural progress during service? (e.) Complete rationale is required for each opinion rendered. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Donna D. Ebaugh, 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.