Citation Nr: 18151028 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 10-27 567A DATE: November 16, 2018 ORDER New and material evidence having been submitted, the application to reopen a previously denied claim for entitlement to service connection for a gastrointestinal disorder, to include as due to service in the Southwest Asia Theater of Operations, is granted. New and material evidence having been submitted, the application to reopen a previously denied claim for entitlement to service connection for a low back disorder is granted. New and material evidence having been submitted, the application to reopen a previously denied claim for entitlement to service connection for a bilateral hip disorder is granted. Entitlement to service connection for a functional gastrointestinal disorder as due to service in the Southwest Asia Theater of Operations is granted. Entitlement to service connection for a low back disorder is granted. Entitlement to service connection for a bilateral hip disorder is granted. Entitlement to service connection for chronic sleep impairment as due to service-connected posttraumatic stress disorder (PTSD) is granted. Entitlement to service connection for a neck disorder is denied. Entitlement to service connection for blurred vision is denied. REMANDED Entitlement to service connection for a bilateral shoulder disorder is remanded. FINDINGS OF FACT 1. In July 1995, service connection for a gastrointestinal disorder was denied; a notice of disagreement and/or new and material evidence was not submitted within one year of notice of the decision. 2. The evidence added to the record since the July 1995 decision relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a gastrointestinal disorder. 3. In October 2006, service connection for a low back disorder was denied; a notice of disagreement and/or new and material evidence was not submitted within one year of notice of the decision. 4. The evidence added to the record since the October 2006 decision relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a low back disorder. 5. In October 2006, service connection for a bilateral hip disorder was denied; a notice of disagreement and/or new and material evidence was not submitted within one year of notice of the decision. 6. The evidence added to the record since the October 2006 decision relates to an unestablished fact necessary to substantiate the claim of entitlement to service connection for a bilateral hip disorder. 7. A functional gastrointestinal disorder, characterized by chronic gastrointestinal symptoms of bloating, diarrhea, and cramping, manifested during active service. 8. The Veteran’s low back disorder and bilateral hip disorder are related to his military service. 9. The Veteran’s chronic sleep impairment is a symptom of his service-connected PTSD. 10. The Veteran’s neck disorder is not related to military service. 11. The Veteran’s blurred vision is not related to military service. CONCLUSIONS OF LAW 1. The July 1995 decision that denied the Veteran’s claim for entitlement to service connection for a gastrointestinal disorder is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 2. As the evidence received subsequent to the July 1995 rating decision is new and material, the requirements to reopen the claim for entitlement to service connection for a gastrointestinal disorder have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 3. The October 2006 decision that denied the Veteran’s claim for entitlement to service connection for a low back disorder is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 4. As the evidence received subsequent to the October 2006 rating decision is new and material, the requirements to reopen the claim for entitlement to service connection for a low back disorder have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 5. The October 2006 decision that denied the Veteran’s claim for entitlement to service connection for a bilateral hip disorder is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. 6. As the evidence received subsequent to the October 2006 rating decision is new and material, the requirements to reopen the claim for entitlement to service connection for a bilateral hip disorder have been met. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.102, 3.156. 7. The criteria for entitlement to service connection for a functional gastrointestinal disorder as due to service in the Southwest Asia Theater of Operations have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.317. 8. The criteria for entitlement to service connection for a low back disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 9. The criteria for entitlement to service connection for a bilateral hip disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 10. The criteria for entitlement to service connection for a sleep disorder as due to service-connected PTSD have been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 11. The criteria for entitlement to service connection for a neck disorder have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 12. The criteria for entitlement to service connection for blurred vision have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1980 to June 1994 and from January 1999 to February 2005. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2009 rating decision by the Department of Veterans Affairs (VA). The Veteran attended a hearing before a Decision Review Officer in December 2017. This case was previously remanded by the Board in July 2015 and July 2017. In July 2018, the Veteran withdrew his hearing request for a Board hearing. Accordingly, the Board will continue adjudication of the appeal without the hearing. See 38 C.F.R. § 20.704(d), (e). The Veteran’s claim for entitlement to service connection for a right knee disorder was granted in a June 2018 rating decision. Although the Veteran has now disagreed with his assigned rating, that appeal is not currently before the Board. New and Material Evidence In order for evidence to be sufficient to reopen a previously disallowed claim, it must be both new and material. If the evidence is new, but not material, the inquiry ends and the claim cannot be reopened. See Smith v. West, 12 Vet. App. 312, 314 (1999); Manio v. Derwinski, 1 Vet. App. 140 (1991). Under the relevant regulation, “new” evidence is defined as evidence not previously submitted to agency decision-makers. “Material” evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. If it finds that the submitted evidence is new and material, VA may then proceed to evaluate the merits of the claim on the basis of all evidence of record, but only after ensuring that the duty to assist the veteran in developing the facts necessary for the claim has been satisfied. See Elkins v. West, 12 Vet. App. 209 (1999); but see 38 U.S.C. § 5103A (eliminates the concept of a well-grounded claim). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low, and consideration is not limited to whether the newly submitted evidence relates specifically to the reason the claim was last denied. Rather, consideration should include whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary’s duty to assist or through consideration of an alternative theory of entitlement. See Shade v. Shinseki, 24 Vet. App. 110, 117-18 (2010). 1. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a gastrointestinal disorder, to include as due to service in the Southwest Asia Theater of Operations 2. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a low back disorder 3. Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a bilateral hip disorder The Veteran is seeking service connection for a gastrointestinal disorder, low back disorder, and bilateral hip disorder. The claims were previously denied in unappealed rating decisions of July 1995 (gastrointestinal disorder) and October 2006 (low back and bilateral hip disorders). Based on the additional evidence added to the record since the previous final denial of the Veteran’s claims, the Board finds that new and material evidence has been added to the record. The Veteran’s claim of service connection for a gastrointestinal disorder was denied in a July 1995 rating decision. The basis for the denial of service connection was that although the Veteran made multiple gastrointestinal complaints in service, the symptoms lasted less than the six months required for eligibility under the regulations governing claims related to service in Southwest Asia. See 38 C.F.R. § 3.317. He did not file a Notice of Disagreement or submit new and material evidence within one year of the decision. Therefore, the rating decision became final and represents the last final denial of the claim. The Veteran’s claim of service connection for a low back disorder was denied in an October 2006 rating decision. The basis for the denial of service connection was that even though he was diagnosed with myofascial pain syndrome due to muscle spasm in service, it resolved. As a result, he had no current disability. The Veteran’s claim of service connection for a bilateral hip disorder was also denied in the October 2006 rating decision. The basis for the denial of service connection was that although he had been diagnosed with hip strain, there was insufficient evidence demonstrating a nexus with military service. He did not file a Notice of Disagreement or submit new and material evidence within one year of the October 2006 decision. Therefore, the rating decision became final with respect to both claims and represents the last final denial of the claims. Since the last final denials of all three claims, additional evidence has been added to the record. Additional treatment records and the Veteran’s statements demonstrate that his gastrointestinal disorder has continuously affected him since service. This evidence is material as it contradicts the earlier rating decision which indicated that the Veteran’s gastrointestinal disorder lasted less than six months. With regards to his low back disorder, the Veteran’s physician provided a medical diagnosis as well as positive nexus opinion in December 2017. Finally, with regards to the bilateral hip disorder, a July 2008 Gulf War Examination report contains continued complaints of hip problems, which suggests a possible nexus with military service. The new evidence for the low back disorder and bilateral hip disorder claims is also material as it serves to demonstrate both a current disability and nexus with military service. Consequently, the Board concludes that the reopening of the claims for entitlement to service connection for a gastrointestinal disorder, low back disorder, and bilateral hip disorder is warranted. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995). VA must give due consideration to all pertinent medical and lay evidence in a case where a veteran is seeking service connection. 38 U.S.C. § 1154(a). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the veteran. 38 U.S.C. § 5107(b). Under 38 U.S.C. § 1117(a)(1), compensation is warranted for a Persian Gulf Veteran who exhibits objective indications of a “qualifying chronic disability” that became manifest during service on active duty in the Armed Forces in the Southwest Asia Theater of operations during the Persian Gulf War, or to a degree of 10 percent during the presumptive period prescribed by the Secretary. Effective October 16, 2012, VA extended the presumptive period in 38 C.F.R. § 3.317(a)(1)(i) through December 31, 2016 (for qualifying chronic disabilities that become manifest to a degree of 10 percent or more after active duty in the Southwest Asia Theater of operations). See 77 Fed. Reg. 63225 (2012). Furthermore, the chronic disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a), (b). The Board notes that Congress revised 38 U.S.C. § 1117, effective March 1, 2002. In the revised statute, the term “chronic disability” was changed to “qualifying chronic disability,” and the definition of “qualifying chronic disability” was expanded to include (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. Signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to: (1) fatigue, (2) unexplained rashes or other dermatological signs or symptoms, (3) headache, (4) muscle pain, (5) joint pain, (6) neurological signs and symptoms, (7) neuropsychological signs or symptoms, (8) signs or symptoms involving the upper or lower respiratory system, (9) sleep disturbances, (10) gastrointestinal signs or symptoms, (11) cardiovascular signs or symptoms, (12) abnormal weight loss, and (13) menstrual disorders. 38 C.F.R. § 3.317(b). Functional gastrointestinal disorders are considered to be medically unexplained chronic multi-symptom illnesses. Functional gastrointestinal disorders are a group of conditions characterized by chronic or recurrent symptoms that are unexplained by any structural, endoscopic, laboratory, or other objective signs of injury or disease and may be related to any part of the gastrointestinal tract. Specific functional gastrointestinal disorders include, but are not limited to, irritable bowel syndrome, functional dyspepsia, functional vomiting, functional constipation, functional bloating, functional abdominal pain syndrome, and functional dysphagia. These disorders are commonly characterized by symptoms including abdominal pain, substernal burning or pain, nausea, vomiting, altered bowel habits (including diarrhea, constipation), indigestion, bloating, postprandial fullness, and painful or difficult swallowing. Diagnosis of specific functional gastrointestinal disorders is made in accordance with established medical principles, which generally require symptom onset at least 6 months prior to diagnosis and the presence of symptoms sufficient to diagnose the specific disorder at least 3 months prior to diagnosis. 38 C.F.R. § 3.317 (a)(2)(i)(B)(3). 4. Entitlement to service connection for a gastrointestinal disorder, to include as due to service in the Southwest Asia Theater of Operations The Veteran contends that he suffers from an unspecified gastrointestinal disorder that was caused by his service in the Southwest Asia Theater of Operations. Initially, the Board notes the Veteran served in Southwest Asia form December 1990 to April 1991. As a result, the regulations cited above are applicable to his claim. The Veteran’s service treatment records reflect multiple complaints of a gastrointestinal nature soon after the Veteran’s return from service in Southwest Asia. In June 1992, he complained of abdominal discomfort of an unknown etiology. In December 1992, he complained of abdominal bloating for approximately a year and received a provisional assessment of hiatal hernia versus a duodenal ulcer. During his February 1994 separation examination, he specifically reported stomach indigestion and recurrent stomach problems. Furthermore, during a December 1994 interview for the Persian Gulf Registry, he reported a bloating sensation in the right upper quadrant of the abdomen with occasional diarrhea and cramping. During a December 2017 VA examination, the examiner noted the Veteran’s complaints of diarrhea, cramping, bloating, and gas due to his military service. The examiner noted that although the Veteran claimed to have irritable bowel syndrome, he has never been diagnosed with the disorder. Instead, the examiner characterized his symptoms during service as acute episodes and concluded that his gastrointestinal issues are less likely as not related to service. Nevertheless, based upon the evidence of record, the Board finds that a functional gastrointestinal disorder was incurred in service and continued thereafter active service. Although the VA examiner found there was no evidence of irritable bowel syndrome, the Veteran’s statements as to having gastrointestinal symptoms during service are supported by the evidence of record, including service treatment records. There is no evidence that the symptoms have abated. The Board also gives the Veteran’s reports extra credence because he is also a trained medic. Consequently, the Board finds that entitlement to service connection for a functional gastrointestinal disorder as due to service in the Southwest Asia Theater of Operations is warranted. 5. Entitlement to service connection for a low back disorder The Veteran contends that he suffers from a low back disorder that is related to military service. The Board concludes that the Veteran has a current diagnosis of chronic lumbar strain that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran has received various diagnoses for his lower back. These diagnoses include lumbago, chronic lumbar strain, spinal stenosis, lumbar spondylosis, and degenerative disc disease. In an August 2005 VA examination, the examiner determined that the Veteran had been suffering from chronic lumbar strain since 1991. The examiner’s opinion is supported by multiple notations in the Veteran’s service treatment record noting low back pain. Treatment records show that his back problems have continued since his final separation from military service. Consequently, the Board finds that service connection for a low back disorder is warranted. 6. Entitlement to service connection for a bilateral hip disorder The Veteran contends that he suffers from a bilateral hip disorder that is related to military service. The Board concludes that the Veteran has a current diagnosis of chronic bilateral hip strain that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In an August 2005 VA examination, the examiner determined that the Veteran had been suffering from chronic bilateral hip strain since 1991. The examiner attributed the Veteran’s condition as secondary to his service-connected bilateral knee disorder. Although the Veteran’s x-rays were negative, the examiner credited the Veteran’s reports of pain and stiffness as well as indicators of objective pain. Consequently, the Board finds that service connection for a bilateral hip disorder is warranted. 7. Entitlement to service connection for a sleep disorder, to include as due to service in the Southwest Asia Theater of Operations The Veteran contends that he suffers from a sleep disorder that is related to military service, to include his service in Southwest Asia. The Board concludes that the Veteran suffers from chronic sleep impairment as a result of his service-connected posttraumatic stress disorder (PTSD). During a December 1994 interview for the Persian Gulf Registry, the Veteran reported having a “sleep disorder.” In September 2009, a VA provider conducting a mental health intake examination cited the Veteran’s reports of insomnia as at least part of the reason for a referral for a PTSD evaluation. Importantly, during an April 2010 VA examination, the examiner noted the Veteran’s reports of sleep disturbances and nightmares. In their opinion, the examiner cited the Veteran’s chronic sleep impairment as one of the symptoms of the Veteran’s PTSD. Consequently, the Board concludes that the Veteran’s chronic sleep impairment is a symptom of his service-connected PTSD. However, the Veteran should be aware that no change in his actual benefits is expected from this grant of service connection, as the symptomatology associated with his chronic sleep impairment would be duplicative and overlapping with his already service-connected PTSD. The Board notes that a separate rating would constitute the “pyramiding” of ratings for the same underlying disorder, which is prohibited under VA law. See 38 C.F.R. § 4.14; Cf. Amberman v. Shinseki, 570 F.3d 1377, 1381 (Fed. Cir. 2009). 9. Entitlement to service connection for a neck disorder The Veteran asserts that he has a neck disorder that is related to military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Initially, the Board notes that it is questionable whether the Veteran has a current disability with respect to this claim. The Veteran has a diagnosis of upper thoracic stenosis, significant kyphosis of the upper dorsal spine, and multilevel spondylosis. However, it is unclear if any of these constitute a neck disability when the Veteran is already service-connected for a low back disorder. Nevertheless, even if the Board accepts that the Veteran has a current disability, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service treatment records do not reflect complaints of, treatment for, or a diagnosis related to a neck disorder. Significantly, his separation and retirement examinations were absent of any complaints of or observed symptoms related to a neck disorder. Although the Veteran filed his claim in August 2005, which was only six months after his retirement from service, there was no prior indication of any neck disorder. Therefore, no evidence has been presented of a continuity of symptoms since service. In a July 2008 statement, the Veteran stated that he previously underwent a Gulf War Examination where he complained about a neck issue. However, a review of the Veteran’s statements to the Persian Gulf Registry in December 1994 as well as to the Persian Gulf Examination he underwent in January 1995 do not contain any statements regarding neck pain. Considering the fact that the Veteran mentioned multiple other issues, the Board finds it likely that the Veteran would also complain of symptoms related to his neck. As a result, the Board finds that the Veteran’s statements alone are insufficient to grant service connection with regards to both a continuity of symptoms since service. In an August 2018 statement, the Veteran reported that he suffered from joint issues after wearing full combat gear for a year. However, the Veteran’s statement does not explain why there are medical notations for several similar disorders, but none for any neck trouble during his military service. Additionally, there are no treatment records establishing that the Veteran’s claimed neck disorder is related to active duty, nor has any physician asserted that such a relationship exists. The Veteran may believe his neck disorder is related to an in-service injury, event, or disease. He has generally stated that all medical professionals know the human body is connected by muscles, ligaments, nerves, and bones. He further states that when one is injured or out of line, it places stress on other areas. He may have some competency to comment on such a connection due to his background as a combat medic. However, he has not offered a specific medical opinion regarding his neck disorder. Moreover, taking the Veteran’s statement at face value would require the Board to grant service connection for all musculoskeletal disorders. Consequently, the Board gives more probative weight to the above-referenced evidence. Without any basis to suggest that the Veteran’s disorder is related to military service, the Board finds that the weight of the competent evidence does not attribute the Veteran’s asserted neck disorder to military service despite his contentions to the contrary. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 10. Entitlement to service connection for blurred vision, to include as due to service in the Southwest Asia Theater of Operations The Veteran contends that he has blurred vision as a result of his fatigue, the latter of which results from military service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. Initially, the Board notes that in a July 2018 statement, the Veteran recalled asking the Decision Review Officer to withdraw his claim during the December 2017 hearing. However, a review of the hearing transcript and the rest of the claims file reveals no formal request to withdraw his blurred vision claim. As a result, the Board will still evaluate the Veteran’s claim. The Board notes that it is questionable whether the Veteran has a current disability with respect to this claim. Other than the fact that the Veteran filed his claim, there are no medical records demonstrating that he has such a condition or if he has suffered from such a condition, whether it is a chronic disability. Nevertheless, even if the Board accepts that the Veteran is competent to report blurred vision, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service treatment records do not reflect complaints of, treatment for, or a diagnosis related to blurred vision. Significantly, his separation and retirement examinations were absent of any complaints of or observed symptoms related to blurred vision. The Veteran filed his claim in July 2006, which was more than a year after his retirement from service. Therefore, no evidence has been presented of a continuity of symptoms since service. There are no treatment records establishing that the Veteran’s blurred vision is related to active duty, nor has any physician asserted that such a relationship exists. In a July 2008 statement that initiated the claim on appeal, the Veteran reported that he suffered from blurry vision as a result of his fatigue, the latter of which he was also filing a claim for service connection. However, after he was denied service connection for blurry vision and fatigue, he only chose to appeal the claim for service connection for blurry vision. Therefore, secondary service connection is unavailable. The Veteran has not offered statements or evidence suggesting a direct linkage to service.   Without any basis to suggest that the Veteran’s disorder is related to military service, the Board finds that the weight of the competent evidence does not attribute the Veteran’s asserted blurred vision to military service despite his contentions to the contrary. In reaching the above conclusion, the Board also considered the doctrine of reasonable doubt. 38 U.S.C. § 5107(b). However, as the most probative evidence is against the claim, the doctrine is not applicable in this case. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Entitlement to service connection for a bilateral shoulder disorder The Veteran contends that he suffers from a bilateral shoulder disorder that is related to his military service. The Veteran has a current diagnosis of bilateral rotator cuff tendinitis. The evidence shows that he occasionally reported shoulder pain and received a diagnosis of bursitis of the left shoulder during service. In a December 2017 private opinion, the Veteran’s own physician opined that the Veteran’s bilateral shoulder rotator cuff tendinitis more than likely began or was permanently aggravated on active duty. However, the opinion is of limited probative value as no rationale is provided for the opinion, which collectively addressed three different disorders. Nevertheless, the Board has determined that the Veteran has presented adequate information to justify further development. As there is insufficient medical evidence to decide the claim, the Veteran should be afforded a VA examination to determine the nature of his bilateral shoulder disorder and the relationship, if any, of such disability to service. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any bilateral shoulder disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including his complaints of shoulder problems during service. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Borman, Associate Counsel