Citation Nr: 22044576 Decision Date: 08/05/22 Archive Date: 08/05/22 DOCKET NO. 19-23 387 DATE: August 5, 2022 REMANDED Service connection for a cervical spine disability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1975 to August 1979. This appeal is before the Board of Veterans' Appeals (Board) from a December 2017 rating decision issued by a Department of Veterans Affairs (VA) regional office. In February 2022, the Veteran testified before the undersigned Veterans Law Judge at a virtual hearing. A copy of the hearing transcript is in the claims file. Service Connection for a Cervical Spine Disability The Veteran attributes his neck problems to an in-service injury in 1977. He testified that he was struck, twice, in the neck, head and shoulders with a 4x4 board while performing his duties. He also testified that he began receiving chiropractic treatment for his neck in January 1980, months after separation. The record contains two VA medical opinions, both of which indicate that the claimed disability is less likely than not related to service. The two VA examiners provided similar reasoning for this conclusion. A July 2018 VA examiner noted evidence of "a cervical [injury] during the 1975 time," but found no documentation to "support the relational injury or pathology that would be affecting his current clinical status of his neck." The 2018 examiner offered no other rationale. An April 2019 VA examiner noted that service treatment records revealed episodes of acute neck pain in November 1977 and February 1978. However, the 2019 examiner found no "documented evidence of continued treatment or complaints during active duty service." The 2018 examiner offered no other rationale. The Board finds the VA medical opinions above inadequate to decide the claim because they lack fully-articulated medical reasoning. They do not sufficiently inform the Board of the examiner's judgment on the medical question and the essential rationale for the opinion. Monzingo v. Shinseki, 26 Vet. App. 97, 105 (2012); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (an opinion is probative when it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data). Furthermore, neither VA opinion adequately addresses the Veteran's lay statements regarding the in-service injury and his history of chiropractic treatment after service. Miller v. Wilkie, 32 Vet. App. 249, 259-60 (2020); see also Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (a VA examiner may not ignore favorable lay evidence and rely solely on the absence of contemporaneous medical evidence). The record also contains a March 2018 letter from "Dr. P.K.," a non-VA chiropractor. Dr. P.K. wrote that the Veteran "has dealt with chronic restriction of cervical and lumbar range of motion related to repetitive stress while in active duty." Dr. P.K. also noted that he has received intermittent chiropractic treatment over the last 30 years. Although this favorable opinion includes more information about the Veteran's medical history, it lacks clear medical reasoning linking the claimed disability to service. Like the VA opinions, it is inadequate to decide the claim. The Board therefore finds that remand to the agency of original jurisdiction for another VA medical opinion is necessary. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). On remand, the examiner must clearly consider and discuss the pertinent lay evidence concerning the onset and history of the disability. This includes the Veteran's Board testimony, his April 2018 personal statement, and the February 2022 statement from his spouse. The examiner must also clearly consider and discuss Dr. P.K.'s March 2018 letter. The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician on whether the Veteran's claimed cervical spine disability is at least as likely as not related to service, to include the reported 1977 injury involving a 4x4 board. Schedule another in-person examination if the examiner deems it necessary to render the requested opinion. The examiner must review the claims file, including this remand. In particular, the examiner must clearly consider and discuss the pertinent lay evidence concerning the in-service injury and the history of the Veteran's symptoms and treatment. This includes the Veteran's February 2022 testimony, his April 2018 personal statement, and the February 2022 statement from his spouse. The examiner must also clearly consider and discuss Dr. P.K.'s March 2018 letter. 2. Review the medical opinion above to ensure substantial compliance with the Board's directives. Take any necessary corrective action. 3. Readjudicate the Veteran's claim. If it remains denied, issue a supplemental statement of the case, and allow the Veteran and his representative the opportunity to respond. Then return to the Board for further appellate review. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.Z. Wall, Associate 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.