Citation Nr: 18148275 Decision Date: 11/07/18 Archive Date: 11/07/18 DOCKET NO. 16-12 823 DATE: November 7, 2018 REMANDED Entitlement to service connection for left shoulder strain is remanded. Entitlement to service connection for a cervical spine disability, claimed as neck pain and stiffness is remanded. Entitlement to service connection for a lumbar spine disability, claimed as lower back pain is remanded. Entitlement to service connection for a left ankle sprain is remanded. Entitlement to service connection for a right ankle sprain is remanded. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1990 to February 1994. This matter is on appeal from an August 2013 rating decision. 1. Entitlement to service connection for left shoulder strain is remanded. 2. Entitlement to service connection for a cervical spine disability, claimed as neck pain and stiffness is remanded. 3. Entitlement to service connection for a lumbar spine disability, claimed as lower back pain is remanded. 4. Entitlement to service connection for a left ankle sprain is remanded. 5. Entitlement to service connection for a right ankle sprain is remanded. The Veteran has asserted that each disability on appeal began during service and has persisted since that time. Service treatment records (STRs) show that, throughout 1993, the Veteran sought treatment for pain and crepitus affecting her shoulder blades, upper back, neck, and lower back due to various activities, including heavy lifting at work, playing sports, and after performing physical training. She was variously diagnosed with rotator strain, overuse syndrome, and lumbar spine strain with pain in the shoulders. The Veteran also sought treatment for a blunt injury to her left ankle in May 1992. See STRs dated May 1992; March, May August, September, and December 1993. During her pre-separation examination, the Veteran also reported having recurrent back pain, foot trouble, and swollen/painful joints. While there are no post-service treatment records until 2012, the Veteran has consistently asserted that the pain and problems affecting her various joints have persisted since service and has explained that she did not seek treatment for her pain because she did not have insurance. The VA physician who examined the Veteran in April 2012 noted the current diagnoses of strain affecting the bilateral shoulders, cervical spine, and lumbar spine, as well as left ankle sprain. He also noted the Veteran’s report that her symptoms began during service. See April 2012 VA examinations. However, in an addendum opinion, another VA clinician stated that, with the information available, his or her best guess would not accurately reflect the situation, as there was no medical documentation of continued care for the claimed disabilities from 1994 to 2012. See August 2012 VA addendum opinion. The August 2012 statement does not appear to consider the Veteran’s competent and consistent report of continued problems after service or explain why a more detailed opinion cannot be provided without resort to mere speculation given the lay and medical evidence of record. Therefore, an additional medical opinion is needed 6. Entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. The TDIU claim is inextricably intertwined with the service connection claims being remanded herein. As such, the TDIU claim is deferred pending the adjudication of the other claims on appeal. The matters are REMANDED for the following action: Arrange to obtain an addendum opinion. After reviewing the record, the examiner should opine whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran’s current bilateral shoulder, cervical spine, lumbar spine, and bilateral ankle disabilities were incurred during or as a result of her military service. (Continued on the next page)   In answering the foregoing, the examiner should consider the Veteran’s service treatment records, the post-service medical evidence, and the Veteran’s description of the onset and progression of her claimed disabilities, including the lay evidence of continued pain and problems since service. A rationale should be provided in support of any opinion offered. If a rationale cannot be made without resort to mere speculation, this must be fully explained. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A.J. Turnipseed, Counsel