Designated for electronic publication only
UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS
No. 16-3658
MICHAEL E. BROWN, APPELLANT,
V.
DAVID J. SHULKIN, M.D.,
SECRETARY OF VETERANS AFFAIRS, APPELLEE.
Before DAVIS, Chief Judge.
MEMORANDUM DECISION
Note: Pursuant to U.S. Vet. App. R. 30(a), this action may not be cited as precedent.
DAVIS, Chief Judge: U.S. Marine Corps veteran Michael E. Brown appeals through counsel a February 16, 2016, decision of the Board of Veterans’ Appeals (Board) that denied disability compensation for a back disorder. The parties have neither requested oral argument nor identified issues they believe require a precedential decision. For the following reasons, the Court will affirm the Board’s February 2016 decision.

I. BACKGROUND
Mr. Brown served on active duty from April 10, 1975, to May 9, 1975. During his service entry examination, he denied experiencing recurrent back pain or joint problems and the examiner described him as having a normal spine.
On April 23, 1975, about 2 weeks after he entered service, Mr. Brown sought medical treatment for back and leg pain. He related that he had fallen down some stairs and injured his back and leg.1

The examiner noted conflicting reports as to the onset of the back and leg pain but estimated a duration of 2 weeks. A different April 23, 1975, treatment record noted that Mr. Brown

1 Mr. Brown has also stated his back problems stem from physical training in service. Record (R.) at 107. had experienced back pain for the past 3 years. An x-ray showed spondylolisthesis2 with a 15% forward slip.
At a subsequent Medical Board proceeding, the Medical Board found that Mr. Brown suffered from spondylolisthesis, which is defined by Army regulations as a “nonacceptable defect.”
It was recommended that Mr. Brown be separated from service.

After service, in January of 1979, Mr. Brown filed a claim for compensation based on his back, but the claim was denied and Mr. Brown did not appeal. In December 2008, he filed a request to reopen his previously denied back claim. VA eventually granted his request and reopened the claim.
In connection with the reopened claim, the Board remanded the matter in June 2012 for a VA examination. The Board’s remand order instructed the examiner “to determine the presence of any back pathology, to include, but not limited to[,] spondylolisthesis. If any back pathology is present, the examiner must ascertain each such disorder’s etiological relationship to the May 1975 diagnosis of spondylolisthesis, and to . . . active service.” R. at 262-64.

In response to the Board’s 2012 remand order, VA obtained a medical examination in September 2013. The September 2013 examiner diagnosed Mr. Brown with spondylolisthesis, degenerative disc disease of the lumbar spine (DDD), and herniated discs with radiculopathy, but opined that none of these conditions were related to service. The examiner explained that spondylolisthesis and spondylolysis are congenital or developmental disorders and that “a superimposed injury is not suspected.” R. at 107. Because x-rays showed spondylolisthesis with slippage within 2 weeks of Mr. Brown’s entering boot camp or experiencing a fall, the examiner found that the condition was much more likely to be congenital than traumatic or degenerative.

The examiner also explained that the disorder can cause low back pain and may become symptomatic after overuse or a fall, but emphasized that this does not imply a permanent aggravation of the underlying condition. The examiner also noted that DDD and herniated discs did not arise until many years after service and, in the intervening years, Mr. Brown held several labor-intensive jobs and sustained other back injuries.

2 “Spondylolisthesis” is the “forward displacement (olisthy) of one vertebra over another, usually of the fifth lumbar over the body of the sacrum, or of the fourth lumbar over the fifth, usually due to a developmental defect in the pars interarticularis.” DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 1754 (32d ed. 2012).
3 Relying primarily on the 2013 VA medical examination, the Board denied service connection for a back disorder. The Board found that compensation is not warranted for spondylolisthesis and spondylolysis because these are congenital conditions that were not aggravated by service, and it declined to award service connection for DDD and herniated discs because there was no evidence they were related to service. The Board noted that Mr. Brown and his family members stated that Mr. Brown has had back problems since service, but found that, as lay persons, they could not offer competent evidence as to the possible etiology and aggravation of Mr. Brown’s back problems, which involve complex medical matters. Mr. Brown now appeals the Board’s decision.

II. ANALYSIS
A. Adequacy of 2013 VA Medical Examination
Mr. Brown argues that the Board erred in relying on the 2013 VA examination. According to Mr. Brown, the examination is inadequate because the examiner (1) Concluded Mr. Brown’s back condition was a congenital defect but also stated that a stress fracture caused the defect, (2) failed to explain how the x-ray evidence supported her conclusion, (3) ignored evidence of permanent aggravation and did not support her conclusion that Mr. Brown’s condition was not aggravated by service, (4) did not consider his lay statements that his back pain had persisted since service, and (5) failed to support her conclusions regarding DDD and herniated discs. He also
argues that the Board inadequately explained why it relied on this examination and erroneously failed to address the lay statements regarding continuity of symptomatology. The Court does not agree.

The duty to assist includes the duty to conduct an adequate medical examination. 38 U.S.C. § 5103A; Stefl v. Nicholson, 21 Vet.App. 120, 123 (2007). An adequate examination is “based upon consideration of the veteran’s prior medical history and examinations and also describes the disability in sufficient detail so that the Board’s ‘evaluation of the claimed disability will be a fully informed one.'” Barr v. Nicholson, 21 Vet.App. 303, 311 (2007) (quoting Ardison v. Brown, 6 Vet.App. 405, 407 (1994)). A medical examination that is based on an inaccurate factual premise lacks probative value, Reonal v. Brown, 5 Vet.App. 458, 461 (1993), as does an examination that
merely lists facts and conclusions with no reasoned explanation connecting the two, Nieves Rodriguez v. Peake, 22 Vet.App. 295, 301 (2008) (explaining that a medical report may not merely draw conclusions from data; rather, it should include “a reasoned medical explanation connecting the two”).

The Court reviews for clear error the Board’s determinations that a medical examination is adequate and the duty to assist has been met. D’Aries v. Peake, 22 Vet.App. 97, 104 (2008) (whether medical examination is adequate is a finding of fact); see also Nolen v. Gober, 14 Vet.App. 183, 184 (2000) (Board’s determination whether the Secretary has fulfilled his duty to assist generally is a finding of fact that the Court reviews under the “clearly erroneous” standard of review). “A factual finding ‘is “clearly erroneous” when although there is evidence to support it, the reviewing court on the entire evidence is left with the definite and firm conviction that a mistake has been committed.'” Hersey v. Derwinski, 2 Vet.App. 91, 94 (1992) (quoting United States v. U.S. Gypsum Co., 333 U.S. 364, 395 (1948)).

As always, the Board is required to support its decision with a written statement of the reasons or bases that is understandable by the claimant and facilitates review by this Court. See 38 U.S.C. § 7104(d)(1); Allday v. Brown, 7 Vet.App. 517, 527 (1995). The statement of reasons or bases must explain the Board’s reasons for discounting favorable evidence, Thompson v. Gober, 14 Vet.App. 187, 188 (2000), discuss all issues raised by the claimant or the evidence of record, Robinson v. Peake, 21 Vet.App. 545, 552 (2008), aff’d sub nom. Robinson v. Shinseki, 557 F.3d 1335 (Fed. Cir. 2009), and discuss all provisions of law and regulation where they are made “potentially applicable through the assertions and issues raised in the record,” Schafrath v. Derwinski, 1 Vet.App. 589, 592 (1991).

Mr. Brown fails to demonstrate that the 2013 examiner’s rationale was inconsistent or unsupported. According to Mr. Brown, the examiner was inconsistent because she concluded that spondylolisthesis was congenital yet also noted that the condition was caused by a stress fracture, and she did not provide support for her conclusion that spondylolisthesis is congenital. Mr. Brown’s argument is based on a faulty parsing of the 2013 examiner’s opinion. With respect to this matter, the examiner stated the following:

According to Harrison’s Text of Medicine, 18th edition, page 132-134, dated 2012, spondylolysis and spondylolisthesis are congenital/developmental disorders.
Spondylolysis is a bony defect in the pars interarticularis. The cause is usually a stress microfracture in a congenitally abnormal segment and occurs in about 6% of adolescents. R. at 106. After having read the examiner’s opinion as a whole, the Court finds the examiner did not, as Mr. Brown contends, find that his back condition was caused by a noncongenital stress fracture. Rather, the clearly expressed import of the opinion is that the cause of spondylolysisthesis is congenital. See Monzingo v. Shinseki, 26 Vet.App. 97, 105 (2012) (statements on a medical examination must not be read in isolation but in the context of the examination “as a whole”) (per curiam). Moreover, the Court finds that, overall, the 2013 examiner’s opinion is consistent and well supported. See id.

Next, contrary to Mr. Brown’s assertion, the examiner explicitly addressed how the x-ray evidence showed that the back disability was congenital and had not permanently increased in severity. Specifically, the examiner explained that because x-rays showed 15% slippage in service in 1975, and test results from 2009 recorded the same percentage of slippage, the x-rays demonstrated that the underlying disability had not worsened. The examiner emphasized that the slippage was unchanged despite years of postservice manual labor work. She also explained that the x-rays showed that the congenital disorder was in the low lumbar spine area while the trauma
and pain noted on active duty were noted to be in the thoracic spine area. This explanation is sufficiently detailed to fully inform the Board’s decision. See Barr, 21 Vet.App. at 311.

Mr. Brown also fails to demonstrate that the 2013 examiner either overlooked evidence of permanent aggravation or improperly discounted the lay evidence. According to Mr. Brown, the lay statements show that he has suffered back pain since service and the examiner should have addressed this evidence of permanent worsening. The 2013 examiner, however, clearly explained that spondylolisthesis can be either “asymptomatic or can cause low back pain and hamstring tightness which was observed on multiple occasions in this case.” R. at 107. The examiner further noted that “while the congenital back problem may have become symptomatic after overuse with
exercise or post a fall, this does not imply a permanent aggravation of the underlying condition.” Id. The examiner emphasized that testing showed no change in slippage associated with Mr. Brown’s condition and that, after service, Mr. Brown worked in labor intensive jobs and was treated for several back injuries. The Court finds that this explanation is detailed and sufficiently supported. See Barr, 21 Vet.App. at 311.

With respect to the lay statements, Mr. Brown also asserts that the Board provided an inadequate statement of reasons or bases because it did not ensure that the 2013 examiner considered the lay statements regarding his back pain. Contrary to this assertion, the Board explicitly found that the “2013 VA examiner considered these statements when providing the medical opinion.” R. at 11. Moreover, the Board did not err in concluding that Mr. Brown and his family members could offer competent evidence regarding his back pain but could not competently opine as to the medically complex question whether spondylolisthesis was permanently worsened by service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (outlining the situations where “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition,” including diagnosing a medically “simple” condition such as a broken leg as opposed to a medically complex condition such as cancer); see also Kahana v. Shinseki, 24 Vet.App. 428, 438 (2011) (Lance, J., concurring) (“[A]ny given medical issue is either simple enough to be within the realm of common knowledge for lay claimants and adjudicators or complex enough to require an expert opinion.”).

Mr. Brown also asserts that the Board’s statement of reasons or bases is internally inconsistent because the Board found “no evidence of symptoms of a lumbar spine disability prior to . . . active service in April 1975” yet also relied on the 2013 examiner’s conclusion that spondylolisthesis is a congenital condition that preceded service. Given the examiner’s explanation, however, that spondylolisthesis is a congenital condition that does not always cause symptoms, the Court discerns no inconsistency in the Board’s statement of reasons or bases and otherwise finds that it is understandable and facilitates judicial review. See Allday, 7 Vet.App. at 527.

Although Mr. Brown asserts that the examiner’s reference to his postservice manual labor employment is based on the unsupported assumption that engaging in such work indicates that his back was not permanently worsened by service, a reading of the examiner’s opinion as a whole does not support this assertion. Rather, it is clear the examiner found that the heavy manual labor and subsequent back injuries showed that the back disorder was congenital because, despite the hard work and additional back injuries, test results showed that the spondylolisthesis condition had remained unchanged.

Furthermore, and contrary to Mr. Brown’s assertion, the examiner did support her conclusions that DDD and herniated discs were not related to service. The examiner explained that these conditions were not service connected because they did not manifest until many years after service and the intervening years included many risk factors such as labor-intensive jobs and back injuries. The examiner also noted the rarity of disc slippage in people who are approximately the age that Mr. Brown was when he was in service. This explanation includes enough detail to inform the Board’s decision. See Barr, 21 Vet.App. at 311.

Although Mr. Brown asserts that the 2013 examiner acknowledged a relationship between DDD, herniated discs, and Mr. Brown’s spondylolysis, reading the opinion as a whole shows that the examiner did not acknowledge such a relationship. Rather, the examiner stated that although there “can be” a relationship between the conditions, there was no such relationship in Mr. Brown’s case. R. at 106-07. Overall, although Mr. Brown disagrees with the 2013 examiner’s conclusions, he fails to demonstrate either that the examination is inadequate or that the Board inadequately explained its reliance on the examination. See Hersey, 2 Vet.App. at 94; see also Allday, 7
Vet.App. at 527.

B. Compliance with Remand Order
Mr. Brown also argues that the Board erred in finding substantial compliance with the terms of its 2012 remand order. A remand order by the Board or the Court imposes on the Secretary a duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet.App. 268, 271 (1998); but see Dyment v. West, 13 Vet.App. 141, 146-47 (1999) (no Stegall violation when the examiner “substantially complied with the Board’s remand order”). Substantial compliance with the terms of a remand is shown when the Secretary’s actions “resolve the issue that required the remand order.” D’Aries v. Peake, 22 Vet.App. 97, 105 (2008); Dyment, 13 Vet.App. at 146-47.

The 2012 Board remand ordered VA to obtain a medical examination that, among other things, “determine[d] the presence of any back pathology, to include, but not limited to a spondylolisthesis” and “if any back pathology [were] present . . . ascertain[ed] each such disorder’s etiological relationship to the May 1975 diagnosis of spondylolisthesis, and to . . . active duty service.” R. at 264. Although Mr. Brown contends that the terms of the Board remand were not complied with because the 2013 examination is inadequate, as noted above, he fails to show any inadequacy in the 2013 examination. Furthermore, despite his contention that the 2013 examiner should have considered whether his back spasms and hamstring tightness were related to service, the 2013 examination notes these conditions but nonetheless determined that no currently diagnosed conditions were related to service. To the extent that Mr. Brown raises other contentions of error, the Court finds they are too vague or unsupported by evidence and argument to permit judicial review. See Evans v. West, 12 Vet.App. 22, 31 (1998) (Court will give no consideration to a “vague assertion” or an “unsupported contention”). In sum, Mr. Brown fails to meet his burden of demonstrating error in the Board’s decision. See Hilkert v. West, 12 Vet.App. 145, 151 (1999) (en banc) (appellant bears burden of demonstrating error on appeal).

III. CONCLUSION
On consideration of the foregoing, the Board’s February 16, 2016, decision is AFFIRMED.
DATED: November 7, 2017
Copies to:
Meghan Gentile, Esq.
VA General Counsel (027)