Citation Nr: 18145217 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 10-45 002 DATE: October 30, 2018 REMANDED Entitlement to service connection for post-operative cervical spondylosis and stenosis (claimed as chipped bone in the neck), to include as secondary to service-connected degenerative arthritis residuals of acromioclavicular separation, right shoulder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Air Force from November 1962 to January 1964. This case comes before the Board of Veterans’ Appeals (the Board) from a February 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran had a hearing before the undersigned Veterans’ Law Judge in July 2016. A transcript of that proceeding has been associated with the claims file. Entitlement to service connection for post-operative cervical spondylosis and stenosis (claimed as chipped bone in the neck), right shoulder, is remanded. This matter was previously remanded in September 2016. The Board, in part, remanded this matter for an addendum opinion regarding the nature and etiology of the Veteran’s neck disability. Accordingly, an addendum opinion was furnished in August 2017 with a clarifying opinion in September 2017. The Board finds that a remand is necessary in order to obtain an additional VA addendum opinion. Primarily, the Veteran has submitted a Written Brief Presentation in February 2018, which asserts that the August 2017 and September 2017 VA opinions are inadequate. The August 2017 VA examiner failed to address all of the questions posed by the Board’s previous remand; and the September 2017 VA examiner was a podiatrist rather than an orthopedist. Moreover, the Board notes that the September 2017 VA examiner appears to state that the Veteran’s neck disability is a congenital disease rather than a defect, but failed to answer whether it is at least as likely as not that the Veteran’s congential disease had its onset in service or is otherwise related to service. For these reasons, the Board remands this matter for an additional addendum opinion by a qualified physician. The matter is REMANDED for the following action: 1. Forward the claims file to the author of the January 2010 VA examination report, or an appropriate substitute orthopedist as necessary . If the examiner determines that the Veteran should be provided another VA examination, one should be scheduled. The examiner should review the entire claims file, to include this remand, and respond to the following: a) Identify any diagnosed cervical spine disabilities present from July 2009. b) State whether the Veteran’s cervical spondylosis and stenosis is a congenital / developmental defect or disease. [Note: a disease generally refers to a condition that is considered capable of improving or deteriorating while a defect is generally not considered capable of improving or deteriorating. VAOPGCPREC 82-90 (1990) (citing Durham v. United States, 214 F.2d 862, 875 (D.C. Circuit 1954)]. Please provide a complete explanation for the opinion, any discrepancies should be addressed as necessary. c) If it is a congenital / developmental defect, explain whether it is at least as likely as not (a probability of 50 percent or greater) that there was a superimposed injury or disease in service that resulted in additional cervical spine disability. Please provide a complete explanation for the opinion. d) If it is a disease, state whether it is at least as likely as not (a probability of 50 percent or greater) that cervical spondylosis and stenosis and any other currently diagnosed cervical spine disability had its onset in service or is otherwise related to service. e) Whether it is at least as likely as not (a probability of 50 percent or greater) that cervical spondylosis and stenosis and any other currently diagnosed cervical spine disability was caused by the Veteran’s service-connected degenerative arthritis residuals of acromioclavicular separation, right shoulder. f) Whether it is at least as likely as not (a probability of 50 percent or greater) that cervical spondylosis and stenosis and any other currently diagnosed cervical spine disability is aggravated by the Veteran’s service-connected degenerative arthritis residuals of acromioclavicular separation, right shoulder. Note that aggravation means that the non-service-connected disability underwent a chronic worsening beyond its natural progression due to the service-connected disability. If aggravation is found, the clinician should address the following medical issues to the extent possible: (1) the baseline manifestations of the Veteran’s cervical spine disability found prior to aggravation; and (2) the increased manifestations which, in the clinician’s opinion, are proximately due to the service-connected degenerative arthritis residuals of acromioclavicular separation, right shoulder. In formulating the opinions, the term “at least as likely as not” does not mean “within the realm of possibility.” Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against. The clinician is requested to comment on the January 2014 VA shoulder and arm examination report which noted that shoulder abduction caused the Veteran to experience a severe burning pain from the right side of his neck to his right hand and fingers. Any opinions offered should be accompanied by the underlying reasons for the conclusions. If the clinician is unable to offer any of the requested opinions, it is essential that the he or she offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2011). 2. Thereafter, ensure completion of the foregoing and any other development deemed necessary, then readjudicate the Veteran’s claim. If the requested benefit remains denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case and an opportunity to respond. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs