Citation Nr: 18160452
Decision Date: 12/27/18	Archive Date: 12/26/18

DOCKET NO. 16-09 119
DATE:	December 27, 2018
Entitlement to service connection for a low back disability is remanded.
Entitlement to a compensable rating for kidney stone residuals, status post ureterolithotomy/nephrolithiasis is remanded.
The Veteran, who is the appellant in this case, had service from June 1966 to January 1990.
In August 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file.
1. Entitlement to service connection for a low back disability is remanded.
A review of the record reflects another opinion is necessary regarding the issue of service connection for a low back disability.  Once VA undertakes to provide a VA examination, it must ensure that the examination is adequate.  Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).  The VA examination medical opinion failed to provide an adequate rationale to support the conclusion or discuss the contrary evidence associated with the record that supports the Veteran’s claims.  Nieves–Rodriguez, 22 Vet. App. 295, 304 (2008) (concluding that a medical opinion is not entitled to any weight if it does not contain a rationale that adequately connects data and conclusions).  In addition, the opinion lacks any discussion of the whether the Veteran’s current diagnosis for lumbar degenerative disc disease is related to the history of recurrent low back pain during service.  Rather, the examiner opined that the Veteran does not currently have a diagnosis of low back strain and therefore the low back pain during service did not continue.  The examiner also did not discuss whether the Veteran experienced continuous low back pain symptoms since service, which he is competent to endorse.  Without further clarification, the Board is without medical expertise to determine the nature and etiology of the claimed disabilities.  Colvin v. Derwinski, 1 Vet. App. 171 (1991).  In light of the above, the Board finds that a new VA examination opinion must be obtained for the low back disability.
2. Entitlement to a compensable rating for kidney stone residuals, status post ureterolithotomy/nephrolithiasis, effective August 23, 2002 is remanded.
The Veteran testified before the undersigned in August 2017 and endorsed increased worsening of his kidney stones disability since his last VA examination in October 2013.  He explained that he has had more frequent instances of kidney stones that required medical attention.  However, the Board is without the expertise necessary to determine the extent of worsened symptoms exhibited by the Veteran’s disability.  “VA regulations specifically require the performance of a new medical examination ... [when] ‘evidence indicated there has been a material change in a disability or that the current rating may be incorrect.’”  Caffrey v. Brown, 6 Vet. App. 377, 381 (quoting 38 C.F.R. § 3.327(a)) (1994).  As there is evidence indicating that the Veteran’s condition has worsened since his last VA examination of record, the Board finds that the Veteran’s claim should be remanded to provide him with an updated examination to accurately assess the current condition of this disability.  In claims for a rating increase, it is first and foremost a priority to ensure that the most current assessment of the service-connected disability picture is of record.  See Green v. Derwinski, 1 Vet. App. 121, 124 (1991).  He also identified private treatment records that have not been associated with the record.  Specifically, he stated that he visits his urologist at least twice a year for check-ups.  
The matter is REMANDED for the following action:
1. Ask the Veteran to complete a VA Form 21-4142 for kidney stone treatment, to include his treatment through Tricare.  Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile.
2. Obtain the Veteran’s VA treatment records for the period from March 2016 to the Present.
3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any low back disability.  The examiner must opine on the following:
(a.) whether it is at least as likely as not related to an in-service injury, event, or disease, including the noted history of low back pain at separation from service.
(b.) whether it at least as likely as not (1) began during active service, (2) manifested within one-year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service.  The examiner should also discuss the relationship, if any, between the Veteran’s noted history of low back pain during service, any endorsements of continued low back pain since service, and his development of advanced degenerative changes of the lumbosacral spine.
4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected kidney stone residuals.  The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria.  To the extent possible, the examiner should identify any symptoms and functional impairments due to kidney stone residuals alone and discuss the effect of the Veteran’s kidney stone residuals on any occupational functioning and activities of daily living.  

Veterans Law Judge
Board of Veterans’ Appeals

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