Citation Nr: 0001811 Decision Date: 01/21/00 Archive Date: 01/28/00 DOCKET NO. 98-16 147A ) DATE ) ) On appeal from the Department of Veterans Affairs Medical and Regional Office Center in Wichita, Kansas THE ISSUE Entitlement to service connection for a low back disorder, to include as secondary to the service-connected epididymitis/groin muscle strain. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD Siobhan Brogdon, Counsel INTRODUCTION The veteran served on active duty from September 1988 until September 1991 and from October 1992 until October 1996. This appeal comes before the Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) from a rating decision in April 1998 from the Wichita, Kansas Medical and Regional Office Center (RO) which denied service connection for a low back disorder, to include as secondary to the service-connected epididymitis/groin muscle strain. FINDINGS OF FACT 1. Service connection has been established for groin muscle strain. 2. A VA physician concluded upon physical examination in May 1999 that pain in the veteran's groin and low back areas were related. CONCLUSION OF LAW The claim of entitlement to service connection for a low back disorder, to include as secondary to the service-connected epididymitis/groin muscle strain, is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The threshold question that must be resolved in this appeal is whether the appellant has presented evidence that the claim is well grounded; that is, that the claim is plausible. In order for a direct service connection claim to be well grounded, there must be (1) a medical diagnosis of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between an in- service injury or disease and the current disability. Epps, 126 F.3d at 1468; Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996) (per curiam) (table). In order for there to be a well-grounded claim for service connection for disability as secondarily due to service-connected disability, there must be competent (i.e. medical) demonstration of current disability, as well as competent evidence of a nexus between current disability and service-connected disability. Where the determinative issue involves medical causation or etiology, or a medical diagnosis, competent medical evidence to the effect that the claim is "plausible" or "possible" is required. Epps, 126 F.3d at 1468. Further, in determining whether a claim is well-grounded, the supporting evidence is presumed to be true and is not subject to weighing. King v. Brown, 5 Vet.App. 19, 21 (1993). A well-grounded claim can also be established under 38 C.F.R. § 3.303(b) (1999) by (1) evidence that a condition was "noted" during service or during an applicable presumption period; (2) competent evidence showing post service continuity of symptomatology; and (3) competent evidence of a nexus between the present disability and the post service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-97 (1997). The veteran was shown to have had a groin muscle strain in service associated with a low back complaint on at least one occasion, and a VA physician has opined that the two conditions are related. The Board finds that this opinion is sufficient competent evidence to establish the possibility of a nexus between the currently identified low back disorder and the injury to the groin muscle in service. In view of the foregoing, the Board finds that the veteran has met his burden with respect to submission of a well- grounded claim for service connection for a low back disorder, to include as secondary to the service-connected epididymitis/groin muscle strain. ORDER The claim of entitlement to service connection for a low back disorder, to include as secondary to the service-connected epididymitis/groin muscle strain is well grounded. To this extent only, the appeal is granted. REMAND Because the claim of entitlement to service connection for a low back disorder, to include as secondary to the service- connected epididymitis/groin muscle strain, is well grounded, VA has a duty to assist the appellant in developing facts pertinent to the claim. 38 U.S.C.A. § 5107(a) (West 1991); 38 C.F.R. § 3.159 (1999); Murphy v. Derwinski, 1 Vet. App. 78 (1990). The Board notes that while a treating physician stated in May 1999 that the service-connected groin muscle disorder and the back pain were related, and presented reasons for why she thought this was the case, it is demonstrated that he had multiple evaluations and treatment over the years for his groin symptoms which did not refer to any significant low back problem or complaints. While the veteran did indicate in June 1994 that he had low back pain, no diagnosis pertaining to the lumbar spine was rendered until April 1998 when disc changes were observed at multiple levels. Additionally, it is not clear as to whether the VA physician had the entire record before her before making her assessments in May 1999. In view of such, the Board finds that more corroborating evaluation by a specialist is indicated as to this matter for a more comprehensive assessment of the clinical data, and that further development is warranted. The fulfillment of the VA's statutory duty to assist the appellant includes providing additional VA examination by a specialist when indicated, and conducting a thorough and contemporaneous medical examination, and providing a medical opinion, which takes into account the records of prior medical treatment, so that the disability evaluation will be a fully informed one. See Hyder v. Derwinski, 1 Vet.App. 221 (1991); Green v. Derwinski, 1 Vet.App. 121, 124 (1991). Accordingly, this case is REMANDED for the following actions: 1. The appellant should be scheduled for a special VA examination to be conducted by a board-certified VA neurologist who has not previously examined him, to determine the nature and etiology of any and all low back and groin pain pathology now indicated. All necessary tests and studies, should be performed, and all clinical manifestations should be reported in detail. The examiner must be provided with the appellant's claims folder and a copy of this remand for review prior to conducting the examination. The examiner is requested to provide an opinion as to whether it is at least as likely as not that there is any etiological relationship between the veteran's groin and low back conditions, either on a direct incurrence in service basis, or secondary to service-connected disability basis. Based on a review of all medical documentation and history on file, including the service medical records, the examiner should provide an opinion as to whether any current low back disorder or symptomatology was initially manifested in service, or is at least as likely as not secondary to the service-connected epididymitis and groin muscle strain. The examiner should reconcile his/her opinion with any conflicting medical opinion of record. The examination report should set forth in a clear, comprehensive, and legible manner all pertinent findings, and should include complete rationale for the opinions expressed. The examination report should clearly reflect whether a review of the claims folder was performed. The examination report should be returned in a legible narrative format. 2. Following completion of the foregoing, the RO must review the claims folder and ensure that the requested development has been completed in full. If the examination report does not include fully detailed descriptions of pathology or adequate responses to the specific opinions requested, the report must be returned to the examiner for corrective action. 38 C.F.R. § 4.2 (1999). 3. The appellant should be given adequate notice of the examination, to include advising him of the consequences of failure to report. If he fails to appear for the examination, this fact should be noted in the claims folder and a copy of the examination notification or refusal to report notice, whichever is applicable, should be obtained by the RO and associated with the claims folder. 4. Following completion of the requested development, the agency of original jurisdiction should readjudicate the issue of entitlement to service connection for a low back disorder, to include as secondary to the service-connected epididymitis/groin muscle strain to determine whether or not it may be granted. If action remains adverse to the appellant, he should be furnished a supplemental statement of the case and be given the opportunity to respond. The case should then be returned to the Board for further appellate consideration. The purpose of the REMAND is to obtain additional development. The Board does not intimate any opinion as to the merits of the case either favorable or unfavorable at this time. The veteran is free to submit any additional evidence he desires to have considered in connection with his current appeal. No action is required of the appellant until he is notified. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded to the regional office. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment by the RO. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See The Veterans' Benefits Improvements Act of 1994, Pub. L. No. 103-446, § 302, 108 Stat. 4645, 4658 (1994), 38 U.S.C.A. § 5101 (West Supp. 1999) (Historical and Statutory Notes). In addition, VBA's Adjudication Procedure Manual, M21-1, Part IV, directs the ROs to provide expeditious handling of all cases that have been remanded by the Board and the Court. See M21-1, Part IV, paras. 8.44- 8.45 and 38.02-38.03. U. R. POWELL Member, Board of Veterans' Appeals