Citation Nr: 23010703 Decision Date: 02/21/23 Archive Date: 02/21/23 DOCKET NO. 18-36 843 DATE: February 21, 2023 ORDER Entitlement to service connection for a right shoulder disorder, to include as secondary to asbestos exposure, is denied. Entitlement to service connection for a left shoulder disorder, to include as secondary to asbestos exposure, is denied. Entitlement to service connection for a lumbar spine disorder, to include as secondary to asbestos exposure, is denied. Entitlement to service connection for osteoarthritis, to include as secondary to asbestos exposure, is denied. Entitlement to service connection for fibromyalgia, to include as secondary to asbestos exposure, is denied. Entitlement to service connection for interstitial cystitis, to include as secondary to asbestos exposure, is denied. Entitlement to service connection for chronic fatigue, to include as secondary to asbestos exposure, is denied. REMANDED Entitlement to service connection for a cervical spine disorder is remanded. FINDINGS OF FACT 1. The appellant's right knee shoulder disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service. 2. The appellant's left shoulder disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service. 3. The appellant's lumbar spine disorder is not shown to be causally or etiologically related to any disease, injury, or incident in service. 4. The appellant's osteoarthritis is not shown to be causally or etiologically related to any disease, injury, or incident in service. 5. The appellant's fibromyalgia is not shown to be causally or etiologically related to any disease, injury, or incident in service. 6. The evidence of record is against finding that the appellant has, or has had at any time during the appeal, a current diagnosis of interstitial cystitis. 7. The evidence of record is against finding that the appellant has, or has had at any time during the appeal, a current diagnosis of chronic fatigue. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left knee disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for a lumbar spine disorder have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for osteoarthritis have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for interstitial cystitis have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for chronic fatigue have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant served in the United States Army Reserves from January 1975 to November 1994; she had no period of active service or periods of active duty for training (ACDUTRA) of 90 consecutive days. These matters come to the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. This case was previously before the Board in April 2020, at which time the issues currently on appeal were remanded for additional development. Specifically, the matters were remanded to obtain private treatment records from Dr. RF, Dr. JMS, Dr. JS, Dr. RB, and Dr. MH, as well as to obtain Social Security Administration (SSA) records, request that the appellant submit copies of any records in her possession relating to dates of inactive duty for training and active duty for training and request that the appellant provide information regarding the in-service incidents which led to her claimed conditions. Treatment records from Dr. RF and Dr. RB were obtained. The RO attempted to obtain records from the other private providers; however, the providers indicated that the records were no longer available. SSA records were obtained and added to the claims file in April 2020. In an April 2020, the appellant was asked to provide specific information regarding her reported in-service asbestos exposure, to submit any records in her possession related to the dates of inactive duty for training, active duty and active duty for training and information regarding the in-service incident which led to her claimed conditions. The Board therefore determines that there has been substantial compliance with its previous remand. The case has now been returned to the Board for further appellate action. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. § 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). VA has established certain rules and presumptions for chronic diseases, such as arthritis. See 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a); Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). With chronic diseases shown as such in service so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless attributable to intercurrent causes. 38 C.F.R. § 3.303(b). If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. § 3.303(b). In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, chronic diseases are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.307(a)(3), 3.309(a). As the appellant did not serve on active duty for more than 90 days, these provisions are not applicable to the instant matters. Entitlement to service connection for a right shoulder disorder is denied. Entitlement to service connection for a left shoulder disorder is denied. The appellant generally asserts that she has right and left shoulder disorders that are related to her period of active service. In her April 2014 Application for VA Disability Benefits (VA Form 21-526EZ), the appellant indicated that she was applying for VA benefits related to bilateral shoulder pain with knots and adhesion. The application did not contain any additional detail with regard to her claimed right and left shoulder disorders. The appellant's service treatment records are unremarkable for any complaints of, treatment for, or diagnosis of a shoulder disorder during active service. Further, a review of the appellant's post-service medical records shows that the appellant was first diagnosed with bilateral shoulder osteoarthritis in 2005. In this case, the Board finds the most probative evidence weighs against the claims. The first complaints and objective evidence of right and left shoulder arthritis did not occur until more than a decade after service. Rather, the probative evidence shows that the appellant's right and left shoulder osteoarthritis had its onset several years after service, and there is no competent evidence to link the appellant's right and left shoulder disorders with an incident of service. Further, there is no evidence to suggest that if the appellant were exposed to asbestos, that asbestos exposure is related to the appellant's right and left shoulder disorders. While the appellant is competent to report on certain medical issues, she is not competent in this case to link right or left shoulder arthritis to her active service. An opinion of that nature requires medical expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, supra. Moreover, nothing in the record demonstrates that the appellant received any special training or acquired any medical expertise in evaluating a shoulder disorder. See King v. Shinseki, 700 F. 3d 1339, 1345 (Fed. Cir. 2012). Therefore, the appellant is not competent to provide an etiology opinion in this case and the Board assigns no probative weight to the appellant's assertions that her right and left shoulder disorders are related to her active service. VA did not obtain etiology opinions on these issues. VA must provide a medical examination and medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). Here, there is no evidence of right or left shoulder arthritis until more than a decade after the appellant's separation from service. The Court has held that VA is not required to provide a medical examination when there is not credible evidence of an event, injury, or disease in service. See Bardwell v. Shinseki, 24 Vet. App. 36 (2010). Moreover, the appellant has not identified any in-service disease or injury to which these conditions can be linked. Rather, in the February 2015 notice of disagreement (NOD), she stated that she experienced musculoskeletal pain, stiffness, and muscle weakness for approximately 15 to 20 years and that she believed her claimed conditions were related to her time at Fort McClellan and/or Fort Chaffee; however, the appellant did not indicate why she believed that her current shoulder disorders were related to her time at either base or provide any evidence of any in-service injury or event that may have caused her current shoulder disorders. While, as noted above, the appellant herself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Therefore, the Board finds that a VA examination and/or etiology opinion is not necessary to decide the claims for service connection for right and left shoulder disorders. Accordingly, the Board finds that service connection for a right and left shoulder disorder is not warranted. The appeals are denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for a lumbar spine disorder is denied. The appellant generally asserts that she has a lumbar spine disorder that is related to her period of active service. In her April 2014 VA Form 21-526EZ, the appellant indicated that she was applying for VA benefits related to chronic lower back pain. The application did not contain any additional detail with regard to her claimed lumbar spine disorder. The appellant's service treatment records are unremarkable for any complaints of, treatment for, or diagnosis of a lumbar spine disorder during active service. Further, a review of the appellant's post-service medical records shows that the appellant was first diagnosed with lumbar spine osteoporosis in 2005, as well as lumbar spine degenerative disc disease and spina bifida occulta in 2009. In this case, the Board finds the most probative evidence weighs against the claim. The first complaints and objective evidence of a lumbar spine disorder, to include osteoporosis, degenerative disc disease and spina bifida occulta did not occur until more than a decade after service. Thus, the Board finds that presumptive service connection has not been established, and thus, is not warranted for lumbar spine degenerative arthritis. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. Rather, the probative evidence shows that the appellant's lumbar spine disorder had its onset several years after service, and there is no competent evidence to link the appellant's lumbar spine disorder with an incident of service. Further, there is no evidence to suggest that if the appellant were exposed to asbestos, that asbestos exposure is related to the appellant's lumbar spine disorder. VA did not obtain an etiology opinion on this issue. Here, there is no evidence of a lumbar spine disorder until more than a decade after the appellant's separation from service. Moreover, the appellant has not identified any in-service disease or injury to which the condition can be linked. Rather, in the February 2015 NOD, she stated that she experienced musculoskeletal pain, stiffness, and muscle weakness for approximately 15 to 20 years and that she believed her claimed conditions were related to her time at Fort McClellan and/or Fort Chaffee; however, the appellant did not indicate why she believed that her current lumbar spine disorder was related to her time at either base or provide any evidence of any in-service injury or event that may have caused her current lumbar spine disorder. While, as noted above, the appellant herself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or etiology opinion is not necessary to decide the claim for service connection for the lumbar spine disorder. While the appellant is competent to report on certain medical issues, she is not competent in this case to link lumbar spine osteoporosis, degenerative disc disease or spina bifida occulta to her active service. An opinion of that nature requires medical expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, supra; Jandreau v. Nicholson, supra. Moreover, nothing in the record demonstrates that the appellant received any special training or acquired any medical expertise in evaluating a lumbar spine disorder. See King v. Shinseki, supra. Therefore, the appellant is not competent to provide an etiology opinion in this case and the Board assigns no probative weight to the appellant's assertions that her lumbar spine disorder is related to her active service. Accordingly, the Board finds that service connection for a lumbar spine disorder is not warranted. The appeal is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for osteoarthritis is denied. The appellant generally asserts that she has a lumbar spine disorder that is related to her period of active service. In her April 2014 VA Form 21-526EZ, the appellant indicated that she was applying for VA benefits related to osteoarthritis. The application did not contain any additional detail with regard to her claimed osteoarthritis. The appellant's service treatment records are unremarkable for any complaints of, treatment for, or diagnosis of osteoarthritis during active service. Further, a review of the appellant's post-service medical records shows that the appellant was first diagnosed with osteoarthritis in 2005. Post-service records show diagnoses of osteoarthritis related to the above-mentioned disabilities (shoulder and lower back) as well as of the hands, hips and knees. In this case, the Board finds the most probative evidence weighs against the claim. The first complaints and objective evidence of osteoarthritis did not occur until more than a decade after service. The probative evidence shows that the appellant's osteoarthritis had its onset several years after service, and there is no competent evidence to link the appellant's osteoarthritis with an incident of service. Further, there is no evidence to suggest that if the appellant were exposed to asbestos, that asbestos exposure is related to her osteoarthritis. While the appellant is competent to report on certain medical issues, she is not competent in this case to link osteoarthritis to her active service. An opinion of that nature requires medical expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, supra; Jandreau v. Nicholson, supra. Moreover, nothing in the record demonstrates that the appellant received any special training or acquired any medical expertise in evaluating osteoarthritis. See King v. Shinseki, supra. Therefore, the appellant is not competent to provide an etiology opinion in this case and the Board assigns no probative weight to the appellant's assertions that her osteoarthritis is related to her active service. VA did not obtain an etiology opinion on this issue. Here, there is no evidence of osteoarthritis until more than a decade after the appellant's separation from service. Moreover, the appellant has not identified any in-service disease or injury to which the condition can be linked. Rather, as indicated above, in the February 2015 NOD, she stated that she experienced musculoskeletal pain, stiffness, and muscle weakness for approximately 15 to 20 years and that she believed her claimed conditions were related to her time at Fort McClellan and/or Fort Chaffee; however, the appellant did not indicate why she believed that her current lower back disorder was related to her time at either base or provide any evidence of any in-service injury or event that may have caused her current lower back disorder. While, as noted above, the appellant herself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or etiology opinion is not necessary to decide the claim for service connection for osteoarthritis. Accordingly, the Board finds that service connection for osteoarthritis is not warranted. The appeal is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for fibromyalgia, to include as secondary to asbestos exposure, is denied. The appellant generally asserts that she has fibromyalgia, interstitial cystitis and chronic fatigue that is related to her period of active service. In her April 2014 VA Form 21-526EZ, the appellant indicated that she was applying for VA benefits related to osteoarthritis. The application did not contain any additional detail with regard to her claimed fibromyalgia. The appellant's service treatment records are unremarkable for any complaints of, treatment for, or diagnosis of fibromyalgia during active service. Further, a review of the appellant's post-service medical records shows that the appellant was first diagnosed with fibromyalgia in September 2008. In this case, the Board finds the most probative evidence weighs against the claim. The first complaints and objective evidence of fibromyalgia did not occur until more than a decade after service. Rather, the probative evidence shows that the appellant's fibromyalgia had its onset several years after service, and there is no competent evidence to link the appellant's fibromyalgia with an incident of service. Further, there is no evidence to suggest that if the appellant were exposed to asbestos, that asbestos exposure is related to her fibromyalgia. While the appellant is competent to report on certain medical issues, she is not competent in this case to link fibromyalgia to her active service. An opinion of that nature requires medical expertise that is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, supra; Jandreau v. Nicholson, supra. Moreover, nothing in the record demonstrates that the appellant received any special training or acquired any medical expertise in evaluating fibromyalgia. See King v. Shinseki, supra. Therefore, the appellant is not competent to provide an etiology opinion in this case and the Board assigns no probative weight to the appellant's assertions that her fibromyalgia is related to her active service. VA did not obtain an etiology opinion on this issue. Here, there is no evidence of fibromyalgia until more than a decade after the appellant's separation from service. Moreover, the appellant has not identified any in-service disease or injury to which the condition can be linked. Rather, as indicated above, in the February 2015 NOD, she stated that she experienced musculoskeletal pain, stiffness, and muscle weakness for approximately 15 to 20 years and that she believed her claimed conditions were related to her time at Fort McClellan and/or Fort Chaffee; however, the appellant did not indicate why she believed that her current fibromyalgia was related to her time at either base or provide any evidence of any in-service injury or event that may have caused her current fibromyalgia. While, as noted above, the appellant herself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or etiology opinion is not necessary to decide the claim for service connection for fibromyalgia. Accordingly, the Board finds that service connection for fibromyalgia is not warranted. The appeal is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Entitlement to service connection for interstitial cystitis, to include as secondary to asbestos exposure, is denied. Entitlement to service connection for chronic fatigue, to include as secondary to asbestos exposure, is denied. The appellant generally asserts that she has interstitial cystitis and chronic fatigue that is related to her period of active service. In her April 2014 VA Form 21-526EZ, the appellant indicated that she was applying for VA benefits related to osteoarthritis. The application did not contain any additional detail with regard to her claimed interstitial cystitis and chronic fatigue. The appellant's service treatment records are unremarkable for any complaints of, treatment for, or diagnosis of interstitial cystitis and/or chronic fatigue during active service. Further, a review of the appellant's post-service medical records shows that the appellant was not diagnosed with interstitial cystitis or chronic fatigue. As the record does not reflect a current diagnosis related to interstitial cystis or chronic fatigue, the cornerstone element of service connection has not been met, and service connection is not warranted. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (stating that service connection presupposes a current diagnosis of the condition claimed, to at least confirm the appellant has it; without this minimum level of proof, there can be no valid claim). No further discussion of the remaining elements is necessary. The Board acknowledges the Court's holding in Saunders but does not find a basis for determining that there is functional impairment related to interstitial cystitis or chronic fatigue. See Saunders v. Wilkie, 886 F.3d. 1356 (2018). Moreover, the appellant has not alleged manifestations of similar severity, frequency and duration as those VA has determined by regulation would cause impaired earning capacity in an average person. Wait v. Wilkie, 33 Vet. App. 8 (2020). The Board notes that the appellant is competent to report his own symptoms or matters within his personal knowledge. See Jandreau v. Nicholson, supra; Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In addition, laypersons may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (the Board's categorical statement that 'a valid medical opinion' was required to establish nexus, and that a layperson was 'not competent' to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). However, the matter of a medical diagnosis for a disability not capable of lay observation, such as that of interstitial cystitis or chronic fatigue, is a matter within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-38 (1994). In the instant case, there is no suggestion that the appellant has developed an expertise in the diagnosis of interstitial cystitis or chronic fatigue. Therefore, as they do not have the appropriate medical training and expertise to competently diagnose interstitial cystitis or chronic fatigue, the lay assertions in this regard have no probative value. Jandreau, supra at 1377 n.4 ("[s]ometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer"); see also Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). The Board emphasizes that Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. See 38 U.S.C. §§ 1110, 1131. Thus, where, as here, the probative evidence indicates that the appellant does not have current diagnosis of interstitial cystitis or chronic fatigue for the entire appeal period, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, supra. VA did not obtain an etiology opinion on these issues. Here, there is no evidence of interstitial cystitis and chronic fatigue. Moreover, the appellant has not identified any in-service disease or injury to which the condition can be linked. Rather, as indicated above, in the February 2015 NOD, she stated that she experienced musculoskeletal pain, stiffness, and muscle weakness for approximately 15 to 20 years and that she believed her claimed conditions were related to her time at Fort McClellan and/or Fort Chaffee; however, the appellant did not indicate why she believed that her current interstitial cystitis and chronic fatigue was related to her time at either base or provide any evidence of any in-service injury or event that may have caused her current interstitial cystitis and chronic fatigue. While, as noted above, the appellant herself has advanced such a theory, a mere conclusory generalized lay statement that service event or illness caused the claimant's current condition is insufficient to require the Secretary to provide an examination. See Waters v. Shinseki, supra. Therefore, the Board finds that a VA examination and/or etiology opinion is not necessary to decide the claims for service connection for interstitial cystitis and chronic fatigue. In summary, the controlling question in this case is answered in the negative. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, supra. Therefore, as the evidence of record shows that the appellant does not have current diagnosis of interstitial cystitis or chronic fatigue, the Board concludes that service connection is not warranted, and no further discussion of the remaining elements is necessary. See Watson v. Brown, 4 Vet. App. 309, 314 (1993) ("A determination of service connection requires a finding of the existence of a current disability and a determination of a relationship between that disability and an injury or a disease incurred in service."); see also Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (finding that the absence of any one element will result in denial of service connection). Accordingly, the Board finds that service connection for interstitial cystitis and chronic fatigue is not warranted. The appeals are denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND The Board finds that additional development is required before the remaining claims on appeal is decided. Entitlement to service connection for a cervical spine disorder is remanded. At the outset, the Board notes that the issue of entitlement to a cervical spine disorder, previously characterized as spinal stenosis/neck pain, was denied by the RO in the December 2014 rating decision. The appellant filed a timely appeal of this issue in the March 2015 NOD, and the claim was addressed in the May 2018 Statement of the Case (SOC). In July 2018, the appellant submitted a timely VA Form 9 (substantive appeal) with regard to that issue as well as the other issues on appeal. However, the issue was not considered by the Board in the April 2020 remand. The appellate scheme set forth in 38 U.S.C. § 7104(a) contemplates that pertinent evidence will first be reviewed at the agency of original jurisdiction (AOJ) so as not to deprive the claimant of an opportunity to prevail with a claim at that level. See generally Disabled American Veterans v. Secretary of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). When the AOJ receives evidence relevant to a claim properly before it that is not duplicative of evidence already discussed in the statement of the case or a supplemental statement of the case, it must prepare a supplemental statement of the case reviewing that evidence. 38 C.F.R. § 19.31(b)(1). The record reflects that VA-generated evidence, to include private treatment records and ongoing VA treatment records, has been added to the claims file since the claim was last adjudicated in a May 2018 SOC. Since that time, a new supplemental statement of the case was not issued with consideration of the new VA treatment records. While 38 U.S.C. § 7105(e) provides an automatic waiver of initial AOJ review if a veteran submits evidence to the AOJ or the Board with, or after submission of, a Substantive Appeal, this provision is only applicable to cases where the Substantive Appeal was filed on or after February 2, 2013 (applicable here), but does not apply to VA-generated evidence, such as VA examination reports or VA treatment records. 38 U.S.C. § 7105(e). Therefore, a remand is necessary in order to allow the AOJ to consider the newly received evidence in the first instance. 38 C.F.R. § 19.31(b)(1). The matter is REMANDED for the following action: Readjudicate the claim of entitlement to service connection for a cervical spine disorder based on the entirety of the evidence, to specifically include all evidence associated with the record since the issuance of the May 2018 statement of the case. If the claim remains denied, the appellant and her representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher O'Donnell, 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.