Citation Nr: 18149721 Decision Date: 11/14/18 Archive Date: 11/13/18 DOCKET NO. 16-21 385 DATE: November 14, 2018 REMANDED Entitlement to service connection for a bone disorder (including any bone disorder of the shoulders), to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1970 to February 1974. The Veteran claims service connection for osteoporosis, ostearthritis, and bone spurs in both shoulders, to include as secondary to his use of medication for his service-connected asthma with chronic obstructive pulmonary disease, is warranted. As the record includes multiple diagnoses for bone disorders to include osteoarthritis and osteoporosis, the Board has expanded the Veteran’s claim as indicated above. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Entitlement to service connection for a bone disorder, including any bone disorder of the shoulders, is remanded. In February 2015, the Veteran underwent a VA examination to determine the etiology of his bilateral shoulder disorder. The examiner diagnosed the Veteran with mild bilateral shoulder strain. The examiner also opined that it was less likely than not that the Veteran’s claimed condition was proximately due to, or the result of, his service connected condition. The examiner explained that there was no diagnosis rendered for the arthritis joint condition, there was no established medical connection that exists between use of inhaled albuterol medication and the development of arthritis, and the most likely cause of the bilateral shoulder condition was normal aging. In spite of the Agency of Original Jurisdiction’s (AOJ) attempt at providing an adequate VA examination, the Board, nevertheless, finds the February 2015 VA medical opinion insufficient for rating purposes as it was based on an inaccurate factual premise. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). In pertinent part, the February 2015 VA examiner indicated that there was no evidence of arthritis. Yet, this statement appears to be contradicted by the VA treatment records which show multiple diagnoses for osteoarthritis of the bilateral shoulders and an October 2014 magnetic resonance imaging (MRI) test showing AC joint degenerative arthrosis. See October 2014 VA Treatment records. The VA examiner has not, otherwise, attempted to reconcile this contradictory evidence with her findings. Moreover, as indicated above, the Veteran’s claim has been expanded to include various bone disorders. The record also indicates that the Veteran’s bone disorders may be related to his treatment for service-connected asthma with chronic obstructive pulmonary disease. However, no VA examination has been provided to assess specifically whether his diagnosed bone disorders were caused by, or are otherwise related to, his treatment for service-connected asthma with chronic obstructive pulmonary disease. Accordingly, the Board finds that remand is required to provide the Veteran a new VA examination and opinion consistent with the directives herein. McLendon v. Nicholson, 20 Vet. App. 79, 82-3 (2006). The Board also notes that in an August 2014 VA treatment note, the Veteran indicated that he sought treatment at Lumberton hospital and was advised that his osteoporosis was attributable to his asthma medication. See August 2014 VA Treatment records. Nevertheless, the AOJ has not otherwise attempted to obtain these records. Accordingly, on remand, the AOJ should attempt to acquire these records. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment and private treatment records. Specifically, attempt to obtain the private treatment records from Lumberton hospital. All reasonable attempts to obtain such records should be made and documented. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran and his representative must be notified in accordance with 38 C.F.R. § 3.159(e). 2. Following the record development above, obtain a VA medical opinion from an appropriate examiner to assess the etiology of the Veteran’s bone disorder, to include any bone disorder of his shoulders. The examiner must review pertinent documents in the Veteran’s claims file in conjunction with the examination. All indicated studies should be completed. All findings must be fully reported. The examiner should respond to the following: a) What are the bone disorders diagnosed during the course of the appeal, to include any bone disorder of the left and/or right shoulder? b) Provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that any diagnosed bone disorder was caused or aggravated by his treatment (e.g., medication) for his service-connected asthma with chronic obstructive pulmonary disease. Aggravation in this context is defined as “any increase in disability.” Allen v. Brown, 7 Vet. App. 439, 448 (1995). The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. E. Metzner, Associate Counsel