Citation Nr: 18123981
Decision Date: 08/03/18	Archive Date: 08/03/18

DOCKET NO. 15-15 797
DATE:	August 3, 2018
REMANDED
Entitlement to service connection for a back disorder is remanded.
REASONS FOR REMAND
The Veteran served on active duty from July 1988 to March 1997. He served in the United States Navy.
Entitlement to service connection for a back disorder.
Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran’s claim and that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Remand is required for a new VA examination. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007).
The Veteran alleges that his back disorder is due to active service. The Veteran testified at a December 2017 Board hearing that had no problems with his back prior to entering active duty. He further testified that he did a lot of construction work in service as a member of the Seabees, which included lifting and moving heavy objects. He further reported that the onset of his back problems began in November 1991 and that he continued to have back problems throughout the duration of his military career. He further testified that he continued to have symptoms of back pain after service and that he continued to take Tylenol and Advil to treat it; it was not until the pain got severe, approximately 10 to 12 years after discharge from service that he got treatment. 
The Veteran’s service treatment records (STRs) document numerous complaints of back pain, including but not limited to treatment notes from November 1991, May 1993, June 1993, October 1994, and June 1996.
An April 2014 VA examination was conducted. The diagnosis was degeneration of lumbosacral intervertebral discs. The examiner opined that the condition was less likely than not incurred in or caused by the claimed in-service event, noting that spread of symptoms around the areas of the back during service and the absence of the symptoms between the flares strongly suggest the problem was muscular in origin and that the Veteran only had acute and self-limited muscle strain in the military. The examiner further reasoned that it was not until 17 years later that an abnormal plain film MRI result showed definite narrowing of disc spaces with early osteophyte formation and with definite abnormalities. The examiner supported the conclusion by stating that strain does not involve the vertebral bodies or discs, and does not cause damage to them, that there was no evidence of degenerative arthritis or degenerative disc disease in service, that the condition is exceedingly common in the population at large and typically advances with age, and that medical evidence does not suggest that strain causes, predisposes to, or accelerates the development of degenerative arthritis or degenerative disc disease. 
However, the examination report failed to address the physical nature of the Veteran’s in-service military occupational specialty and his lay statements that he continued to experience back pain and symptoms after service, but that he self-medicated.  Thus, a new examination is warranted. 
 
The matter is REMANDED for the following action:
1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative.
2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative.
3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of any diagnosed back disorders. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must elicit from the Veteran a full history and/or description his service.
(a)	The examiner must provide an opinion as to whether each diagnosed back disorder at least as likely as not (50 percent or more probability) had onset in, or is otherwise related to, the Veteran’s active service.
(b)	The examiner must address the following:  1) the Veteran’s STRs; 2) the 2014 VA examination report; 3) the Veteran’s 2017 Board hearing testimony; 4) the Veteran’s military occupational specialty in the Seabees; and 5) statements made in a May 2015 substantive appeal
4. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim.  38 C.F.R.          §§ 3.158, 3.655.  In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address.  It must also be indicated whether any notice that was sent was returned as undeliverable.
5. Ensure compliance with the directives of this remand.  If the report is deficient in any manner, the AOJ must implement corrective procedures.  Stegall v. West, 11 Vet. App. 268, 271 (1998).
 
K. MILLIKAN
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	P. Nguyen, Associate Counsel

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