Citation Nr: 22018380 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 14-21 248 DATE: March 29, 2022 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a right leg disability is remanded. Entitlement to service connection for a left leg disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from July 1970 to November 1972. This matter was before the Board in October 2020, when it was remanded for additional development. Specifically, the Board determined that the Veteran should be afforded new VA examinations for his service connection claims. While the Board regrets further delay, the matter must be remanded for reasons discussion below. In the January 2022 VA opinion, the examiner opined that the Veteran's low back disability and bilateral hip condition were less likely than not related to service. The examiner reasoned that the earliest documentation of back pain was in 2002 or 2003. However, the Veteran submitted a 1994 X-ray report for his back condition. See May 1994 Private Treatment Record, submitted September 2013. The examiner also stated that he was unable to find any complaints of back pain during service, however, the Veteran's service treatment records (STRs) show that he complained of back pain in January 1972. Regarding the Veteran's bilateral hip condition, the examiner reasoned that the earliest documentation of hip pain was during his 2013 VA examination. However, review of the Veteran's medical records reflects reports of hip pain dating back to 2003. See January 2003 Private Medical Treatment Record. Therefore, the Board finds that addendum opinions are warranted for his low back and bilateral hip conditions that considers the medical records discussed above. Lastly, the January 2022 VA examiner did not provide an opinion regarding the Veteran's bilateral leg disability, reasoning that the Veteran does not have a leg diagnosis. The Board notes that in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the United States Court of Appeals for the Federal Circuit found that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability." In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. Review of the Veteran's medical records report leg pain dating back to 2007. Additionally, VA treatment records indicate that the Veteran has a limb leg discrepancy. See September 2015 VA Treatment Record. Therefore, if such functional impairment is shown, an opinion must also be obtained as to the question of whether it is as likely as not related to the Veteran's period of service. The matters are REMANDED for the following action: Forward the record and a copy of this remand to a different examiner than the one that completed the January 2022 examination for completion of addendum opinions. Following review of the record, the examiner should express an opinion as to: a) Whether a low back disability clearly and unmistakably (i.e., obviously, manifestly, or undebatable) pre-existed the Veteran's entry into service. In this regard, the examiner should comment on the significance, if any, of the June 1970 report of medical history wherein the Veteran reported a history of recurrent back pain. If it is the examiner's opinion that a low back disability clearly and unmistakably pre-existed service, the examiner should offer a further opinion as to whether it is also clear and unmistakable that any such disability was NOT aggravated during service beyond its natural progression. The examiner should also offer an opinion as to whether it is at least as likely as not (i.e., whether is it 50 percent or more probable) that the Veteran's current lumbar spine disability was incurred in or is otherwise etiologically related to service. A complete medical rationale for all opinions expressed must be provided. b) Whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) the Veteran's bilateral hip disability had its onset in or is otherwise etiologically related to service. The examiner should clarify whether there is a correlation between the November 1971 in-service injury to the Veteran's current bilateral hip pain. A complete medical rationale for all opinions expressed must be provided. c) Whether any identified bilateral leg disability clearly and unmistakably (i.e., obviously, manifestly, or undebatable) pre-existed the Veteran's entry into service. In this regard, the examiner should comment on the significance, if any, of the June 1970 report of medical history wherein the Veteran reported a history of leg cramps. If it is the examiner's opinion that any identified bilateral leg disability clearly and unmistakably pre-existed service, the examiner should offer a further opinion as to whether it is also clear and unmistakable that any such disability was NOT aggravated during service beyond its natural progression. The examiner should also offer an opinion as to whether it is at least as likely as not (i.e., whether is it 50 percent or more probable) that the Veteran's current disability was incurred in or is otherwise etiologically related to service. If a medical diagnosis cannot be given, the examiner must state whether the Veteran has any functional impairment, such as loss of range of motion, pain, or instability for each of the Veteran's conditions. For any such functional impairment found to be present, the examiner should opine whether it was incurred in or is otherwise etiologically related to service. (Continued on the next page) A complete medical rationale for all opinions expressed must be provided. A.M. CLARK Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Adeleke, T. 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.