Citation Nr: 18140787
Decision Date: 10/05/18	Archive Date: 10/05/18

DOCKET NO. 18-04 628
DATE:	October 5, 2018
REMANDED
Entitlement to service connection for a left shoulder disability, to include as secondary to a service-connected right shoulder disability, is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Army from March 1969 to October 1970. 
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).
1. Entitlement to service connection for a left shoulder disability is remanded.
The October 2017 VA examination report is inadequate, as there is no opinion provided for secondary service connection based on aggravation.  The Veteran also states that his left shoulder disability is entitled to direct service connection based on aggravation of a pre-existing disability.  See November 2017 Notice of Disagreement; see also January 2018 VA Form 9.  In this regard, there is indication that the Veteran’s left shoulder disability may have pre-existed service.  On his July 1968 report of medical examination at entrance, the examining physician noted that he had a history of slight subluxation of the left humeral head.  Accordingly, an addendum opinion adequately addressing both direct and secondary service connection is necessary on remand.  Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).  
The matter is REMANDED for the following action:
Obtain an addendum opinion addressing the etiology of the Veteran’s left shoulder disability.  The entire claims file should be made available to the examiner.  No additional examination is necessary, unless the examiner determines otherwise.  Following a review of the claims file, the examiner is asked to address the following:
(a)	Is there clear and unmistakable (obvious, manifest, and undebatable) evidence that the Veteran’s left shoulder disability existed prior to active service?  Please discuss the July 1968 report of medical examination and other medical evidence supporting your conclusion.
(b)	If the answer to question (b) is yes, is there clear and unmistakable (obvious, manifest, and undebatable) evidence that the pre-existing left shoulder disability WAS NOT aggravated (worsened beyond natural progression) during service?  In addressing this question, please discuss the September 1969 and December 1969 discussing a chronic left shoulder dislocation. 
(c)	If the answer to question (b) is no or the answer to question (b) is yes and question (c) is no, then please presume the Veteran sound at service entry with regard to the left shoulder and opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed left shoulder disability:
(1)	had its onset in or is otherwise related to service, discussing the September and December 1969 notations of chronic left shoulder dislocation therein;
(2)	is proximately due to his service-connected status post right shoulder dislocation; or
(3)	has been aggravated (worsened beyond natural progression) by his service-connected status post right shoulder dislocation (based on overcompensating with the left shoulder due to the right shoulder disability).
Please provide a robust rationale for your conclusions.
 
S. BUSH
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S.S. Mahoney, Associate Counsel