Citation Nr: 18152960 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 16-53 208 DATE: November 26, 2018 REMANDED Entitlement to service connection for right shoulder adhesive capsulitis, to include as due to the service-connected diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1967 to July 1969. This matter comes on appeal before the Board of Veterans’ Appeals (Board) from an April 2012 rating decision, of which the Veteran was sent notice in May 2012, of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a video conference hearing before the Board in his October 2016 substantive appeal, via a VA Form 9. Subsequently, the Veteran requested the Board hearing be cancelled and did not request that it be rescheduled. See September 2018 correspondence. The hearing request is therefore deemed withdrawn. Entitlement to service connection for right shoulder adhesive capsulitis, to include as due to the service-connected diabetes mellitus, is remanded. The Veteran was afforded VA examinations in January 2012 and September 2016. VA medical opinions were also provided in January 2012, April 2016, and September 2016. However, as discussed below, there are no adequate medical opinions of record; thus, the Veteran should be afforded an additional VA examination, and a new medical opinion should be obtained. Once VA undertakes to provide a VA examination, it must ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Initially, the Veteran was afforded a VA examination in January 2012. The VA examiner concluded that it was less likely than not that the Veteran’s diagnosed right shoulder adhesive capsulitis was related to his service-connected diabetes mellitus because there was no evidence of a nexus between the two conditions. This opinion lacked a supporting rationale. The RO obtained an additional VA medical opinion in April 2016. The examiner, an OBGYN, did not physically examine the Veteran but rendered an etiology opinion that the Veteran’s right shoulder adhesive capsulitis was caused by the service-connected diabetes mellitus. In support, the examiner noted there was no history of a prior right shoulder injury or surgery. However, this opinion was factually inaccurate as the record shows the Veteran was diagnosed with a partial rotator cuff tear in the right shoulder in March 2004. As such, the RO requested an additional physical examination of the Veteran and a new medical opinion as to the etiology of the right shoulder adhesive capsulitis. An additional VA examination was afforded to the Veteran in September 2016. The September 2016 examination was performed by the same examiner that provided the April 2016 medical opinion. After physical examination, the examiner concluded that the Veteran did not have adhesive capsulitis, despite a VA orthopedic physician’s diagnosis found in the September 2011 VA treatment records. The examiner noted that the Veteran’s shoulder surgery was for a rotator cuff injury and not for adhesive capsulitis, and the examiner explained that a diagnosis of adhesive capsulitis was a difficult diagnosis that required ruling out several other possible etiologies for the right shoulder stiffness and pain. The examiner also noted that an MRI was not of record, which would have made a more definitive diagnosis. Finally, the examiner noted that, while speculative, he believed the Veteran was given the initial diagnosis of adhesive capsulitis by his VA orthopedic physician, but that it had resolved as shown by improvement in his right shoulder condition status-post surgery. The April 2016 and September 2016 medical opinions are inadequate in their current forms. First, the April 2016 and September 2016 medical opinions, from the same examiner, contradict each other, are factually inaccurate, and contradict the medical evidence of record. Additionally, the September 2016 VA examiner’s opinion is confusing. The examiner indicated that the Veteran never actually had adhesive capsulitis, despite a diagnosis from his VA orthopedic physician and seven months of treatment at VA. Furthermore, later in the opinion, the examiner concluded that the Veteran’s surgery was to treat a rotator cuff injury and not for adhesive capsulitis. However, the Veteran’s contention is not that his right shoulder surgery was for adhesive capsulitis, but that his adhesive capsulitis was proximately caused or aggravated by his service-connected diabetes mellitus. The September 2016 medical opinion failed to address the Veteran’s contentions. A new VA examination and medical opinion are warranted to address the conflicting medical evidence of record and to obtain an adequate etiology opinion for the Veteran’s right shoulder symptoms. Finally, the September 2016 VA examiner also indicated that an MRI of the Veteran’s right shoulder may aid in making a definitive diagnosis in this case; however, an MRI of the right shoulder has not yet been afforded to the Veteran during the appellate period. The matter is REMANDED for the following action: 1. Obtain any pertinent outstanding VA treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a new VA examination with an appropriate clinician to determine the nature and etiology of the Veteran’s right shoulder adhesive capsulitis. All necessary evaluations and testing should be conducted, to include affording the Veteran an MRI of his right shoulder. If an MRI is not necessary, the examiner must provide an explanation for why it is not necessary. After a thorough review of the claims file, the examiner should address the following: (a) Provide an opinion as to whether the Veteran has a current diagnosis of adhesive capsulitis of the right shoulder either on physical examination or at any time during the appellate period. (b) Discuss the conflicting medical evidence of record, to include the diagnosis of adhesive capsulitis in September 2011 VA treatment records and the September 2016 VA medical opinion. (c) If the examiner determines the Veteran had a current diagnosis of adhesive capsulitis during the appellate period, provide an opinion as to whether it was (1) proximately caused or (2) aggravated by the service-connected diabetes mellitus. (d) Provide an opinion as to whether each currently diagnosed right shoulder disability had its onset or was otherwise related to service. (Continued on the next page)   3. Readjudicate the claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Harper, Associate Counsel