Citation Nr: 1320668 Decision Date: 06/26/13 Archive Date: 07/05/13 DOCKET NO. 06-39 293 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUES 1. Entitlement to service connection for a left shoulder disability. 2. Entitlement to service connection for a left ankle disability. 3. Entitlement to service connection for a cervical spine disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD J. Barone, Counsel INTRODUCTION The Veteran had active service from September 2001 to March 2004. This matter came before the Board of Veterans' Appeals (Board) from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The appeal was remanded in October 2010 and December 2012 for development of the record. The appeal is again REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND As an initial matter, the Board observes that there are numerous addresses associated with the Veteran in the claims file. Her most recent address appears to be on [redacted]. However, the supplemental statement of the case issued in April 2013 by the AMC was sent to a previous address. This document was returned as undeliverable in April 2013. Because it appears that the Veteran did not receive the supplemental statement of the case due to VA administrative error, the AOJ should confirm the Veteran's current address and resend the April 2013 supplemental statement of the case. In the October 2010 remand, the Board ordered that a VA examination be conducted to determine the etiology of the Veteran's claimed disabilities, to include whether they are related to any service-connected disability. In the December 2012 remand, the Board pointed out that the resulting examination report and addendum did not sufficiently respond to the questions posed in the 2010 remand, and so were not adequate for the purpose of deciding the Veteran's claim. The Board directed that the Veteran be examined by a physician who had not previously examined her. The reports of examinations carried out in February 2013 clearly indicate that the Veteran was examined by a physicians assistant rather than a physician. Because the Board specified that the Veteran be examined by a physician, the examinations rendered by the physicians assistant are not compliant with the Board's December 2012 remand order. With respect to the substance of the February 2013 examinations, the examiner stated that there was no cause and effect relationship between the Veteran's claimed conditions and her service connected conditions, and that therefore, they would not have been caused or aggravated by any of her service-connected conditions. This conclusory statement does not provide adequate reasoning for the conclusion that the claimed conditions were not caused or aggravated by the Veteran's service-connected disabilities. Accordingly, the case is REMANDED for the following action: 1. Confirm the Veteran's current address. Send a copy of the April 2013 supplemental statement of the case to the Veteran's current address. 2. Schedule the Veteran for a VA examination, by a physician who has not previously examined her (on a fee basis if necessary), to determine the etiology of her claimed left shoulder, left ankle, and cervical spine disabilities. The claims folder should be forwarded to the examining physician for review, and the examiner should be directed to elicit a complete history from the Veteran, the details of which should be included in the examination report. Following examination, interview of the Veteran, and review of the claims file, the examiner should identify all currently present disability of the left shoulder, left ankle and cervical spine. If the examiner concludes that there is no current disability of the left shoulder, left ankle, or cervical spine, he or she should reconcile that conclusion with the findings of the March 2006 and February 2011 examiners. With respect to any currently present disability of the left shoulder, left ankle, or cervical spine, the examiner should provide an opinion as to whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent) that any such disability is related to any disease or injury in service or was manifested within one year of the Veteran's separation from service on March 24, 2004. The examiner should also provide an opinion as to whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of 50 percent), or less likely than not (i.e., probability less than 50 percent) that any such disability was caused or aggravated by any service-connected disability. The examiner should be advised that the Veteran is service connected for left hip synovitis, tinnitus, left knee chondromalacia, and squamous cervical lesions. If the examiner concludes that a service-connected disability either caused or aggravated the claimed left shoulder, left ankle, or cervical spine disability, he should provide an opinion regarding the degree of aggravation. A discussion of the complete rationale for all opinions expressed should be included in the examination report, to include reference to pertinent evidence where appropriate. If the examiner is unable to offer any of the requested opinions, it is essential that the examiner offer a rationale for the conclusion that an opinion cannot be provided without resort to speculation, together with a statement as to whether there is additional evidence that might enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones. 3. The Veteran is hereby notified that it is her responsibility to report for any examination, and to cooperate in the development of the claim. 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. 4. Upon completion of the development directed above, review the examination reports to ensure that they are compliant with the Board's remand directives. Any deficiencies should be resolved prior to recertification to the Board. 5. Readjudicate the Veteran's claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, she and her representative should be furnished a supplemental statement of the case and afforded an appropriate period of time within which to respond thereto. The statement of the case should be mailed to the Veteran's current address following confirmation of same. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. 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 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ MICHAEL A. PAPPAS Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).