Citation Nr: 18142218 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 10-34 959 DATE: October 15, 2018 REMANDED The issue of entitlement to service connection for a left shoulder disorder is remanded. The issue of entitlement to service connection for a heart disorder is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army from September 1976 to March 1977 and from June 1991 to January 1992. She had additional service with the U.S. Army Reserve and the Army National Guard. The Veteran served in Southwest Asia. In May 2013, the Veteran was afforded a videoconference hearing before a Veterans Law Judge. In March 2018, the Veteran was informed that the Veterans Law Judge who had conducted her May 2013 Board hearing had retired and she, therefore, had a right to an additional hearing before a different Veterans Law Judge. In April 2018, the Veteran indicated that she did not want an additional Board hearing. 1. The issue of entitlement to service connection for a left shoulder disorder is remanded. 2. The issue of entitlement to service connection for a heart disorder is remanded. Remand is required to ensure compliance with the Board’s prior remand directives. The RO’s compliance with the Board’s remand instructions is neither optional nor discretionary. Stegall v. West, 11 Vet. App. 268 (1998). In November 2016, the Board remanded the appeal for verification of the Veteran’s complete periods of service and to obtain all relevant service treatment records (STRs) and service personnel records (SPRs). A Veterans Information Solution (VIS) record states that the Veteran served in the Army National Guard from September 1976 to December 1980 and in the Army Reserve from December 1980 to June 1999. DD214s associated with the file indicate active service in the Army from September 1976 to March 1977 and active duty in the Army from June 1991 to January 1992. A January 2017 VA document listing the Veteran’s service dates begins in March 1977 and ends in October 1994. Remand is necessary to obtain a complete and accurate verification of the Veteran’s service and to reconcile all conflicting service dates. Remand is also necessary to obtain all STRs and SPRs associated with all periods of service. A March 2017 VA 3101 Request for Information indicates that all available STRs were uploaded into VBMS. It states the Veteran’s periods of service, however, as Reserve service from March 1977 to December 1994 and active duty from June 1991 to January 1992. There is no indication that the RO made any attempt to obtain the SPRs as directed by the November 2016 Board Remand and, without a complete verification of all of the periods of service, the Board is unable to determine whether all STRs have been associated with the file. Remand is also necessary to obtain new VA examinations and medical opinions. The November 2016 Board Remand directed the RO to obtain a new VA medical opinion which addressed whether the Veteran had a left shoulder disorder, including arthritis; if a disorder was shown, whether it was caused by service; if no diagnosed disorder was shown, whether there were objective indications of a chronic disability with no known etiology; and whether a diagnosed disorder was the result of a medically unexplained chronic multisymptom illness (MUCMI). The RO obtained an April 2015 VA medical opinion which stated only that the examiner had not examined the Veteran’s left shoulder and, therefore, could not provide an opinion. An October 2017 VA medical opinion stated that there was no indication of arthritis in imaging obtained in 2011 and, therefore, a left shoulder disorder was not caused by service. The examiner did not obtain updated imaging or examine the Veteran despite the passage of 6 years since the 2011 imaging study was completed and did not address the questions of whether left shoulder symptoms were of an unknown etiology or the result of a MUCMI. Therefore, this opinion is inadequate and a new VA examination and opinion must be obtained. A January 2017 VA medical opinion is also inadequate. It indicates that, although the Veteran had chest pain a few years after service separation, the Veteran did not have a diagnosis of coronary artery disease and there was “no basis found in these records to diagnose ‘heart attack.’” A June 2017 VA treatment record states, however, that the Veteran had an “old myocardial infarction” and that the Veteran had coronary artery disease status-post percutaneous transluminal coronary angioplasty in 1994 and 1997. Furthermore, an April 2014 letter from the Veteran’s private physician indicated that she had familial hypercholesterolemia, a genetic condition, which was never identified or treated in service and then contributed to coronary artery disease and atherosclerosis. Given that both private and VA records indicate a history of coronary artery disease, the January 2017 VA medical opinion is inadequate. Remand is necessary to obtain a new VA examination and opinion. The matters are REMANDED for the following action: 1. Contact the National Personnel Records Center (NPRC) and/or the appropriate service entity and request that it (1) verify the Veteran’s complete periods of active service, active duty, active duty for training, and inactive duty for training and (2) forward all STRs and SPRs not already of record associated with such duty for incorporation into the record. The RO and NPRC are advised of the following: *A VIS record states that the Veteran served in the Army National Guard from September 1976 to December 1980 and in the Army Reserve from December 1980 to June 1999. *DD214s associated with the file indicate active service in the Army from September 1976 to March 1977 and active duty in the Army from June 1991 to January 1992. If the RO and/or NPRC determines that the Veteran’s verified service differs from the dates listed above, an explanatory memorandum must be associated with the Veteran’s file. 2. AFTER COMPLETION OF THE ABOVE DIRECTED DEVELOMENT AND ASSOCIATION OF ALL RECORDS WITH THE VETERAN’S FILE, schedule the Veteran for a VA shoulder examination to obtain an opinion as to the nature and etiology of any left shoulder disorder(s). All indicated tests and studies should be accomplished and the findings reported in detail. IMAGING STUDIES MUST BE COMPLETED TO DETERMINE WHETHER THE VETERAN HAS ARTHRITIS OF THE LEFT SHOULDER. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Identify all left shoulder disorders which the Veteran currently has or has had at any point during the pendency of this appeal. (b.) Provide an opinion as to whether each diagnosed left shoulder disorder was caused by any in-service event, disease, disorder, or event, or in any way originated during service. (c.) If the Veteran has no diagnosed left shoulder disorder, provide an opinion as to whether the Veteran’s left shoulder symptoms are signs or symptoms of an undiagnosed illness or an MUCMI. 3. AFTER COMPLETION OF THE ABOVE DIRECTED DEVELOPMENT AND ASSOCIATION OF ALL RECORDS WITH THE VETERAN’S FILE, schedule the Veteran for a VA heart disorders examination to obtain an opinion as to the nature and etiology of all heart disorder(s). All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address whether each diagnosed heart disorder was caused by any in service event, disease, disorder, or event, or in any way originated during service. If the examiner concludes that the Veteran does not have heart disorders that have been previously diagnosed, the examiner must provide an explanation for the differing diagnosis. 4. Readjudicate the issues on appeal. If any benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. N. RIPPEL Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. E. Miller, Associate Counsel