Citation Nr: 18156584 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 14-34 883 DATE: December 10, 2018 REMANDED Entitlement to service connection for arthritis of the back, arm and shoulder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1966 to February 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision. In January 2017, the Veteran testified at a hearing before a Veterans Law Judge. A transcript of the proceeding is associated with the electronic claims file. In May 2018 correspondence, the Board informed the Veteran that the Veterans Law Judge who conducted the January 2017 hearing has since left employment with the Board and offered him another hearing. However, since, the Veteran failed to respond to the May 2018 correspondence, the Board presumes that the Veteran has waived his right to appear at another hearing and this matter shall be considered based on the evidence of record. In June 2018, the Board remanded these matters for further development. Specifically, the Board remanded the issue of the Veteran’s arthritis for VA examinations consistent with its instructions. In September 2018, a VA examination determined that the Veteran’s spinal degenerative disc disease was not diagnosed until 2016 and, due to the lapse in treatment between the Veteran’s service and his condition, was less likely than not related to his active duty service. The examiner did not discuss the Veteran’s post-service back medical care and stated that diagnostic tests of the Veteran’s spine had not been performed. A review of the Veteran’s file indicates that VA medical center records diagnosed the Veteran with lumbar disc disease in January 2006 and that numerous diagnostic tests were undertaken throughout the course of his medical care. As such, the Board finds that the September 2018 VA examination of the Veteran’s lumbar spine was inadequate for adjudication purposes. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). When an examination is inadequate, the Board must remand the case for further development. Bowling v. Principi, 15 Vet. App. 1 (2001), 38 C.F.R. § 4.2. In regard to the Veteran’s claim for arthritis of his arm and/or shoulder, the Board’s June 2018 remand specifically asked that a determination of the presence of arthritis of the arm and shoulder be made. However, a September 2018 VA examination did not diagnose the Veteran with any condition of his arm or shoulder and did not perform any diagnostic tests which would have indicated if he had arthritis. As such, the Board finds that the September 2018 VA examination is inadequate for adjudication purposes and the issue of arthritis of the Veteran’s arm and shoulder must be remanded for further development. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA medical examination by a physician (M.D.) to determine the nature and etiology of his diagnosed lumbar spine arthritis and any diagnosed arthritis of his arm and/or shoulder. The claims file, including a copy of this Remand, must be made available to the examiner and the examiner should indicate in his/her report whether or not such was reviewed. All necessary tests and studies should be accomplished, including diagnostic testing of the Veteran’s bilateral shoulders. The examiner should: (a.) Identify any diagnosed arthritis of the Veteran’s arm and/or shoulder; (b.) If there is a diagnosis of any arm and/or shoulder arthritis, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that such a disability had onset in service or within one year following separation from service, or was causally related to service. (c.) for the Veteran’s diagnosed lumbar spine disc disease, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s lumbar spine disc disease had onset in service or within one year following separation from service, or was causally related to service. The examiner must provide a complete rationale on which his/her opinion is based, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. The Veteran’s lay assertions as to onset and continuity and symptomatology, including his January 2017 hearing testimony, should be recorded and considered. While the Board believes an in-service injury occurred, as alleged, and finds that the Veteran’s lay statements are credible, it cannot make a medical determination as to whether the claimed disability is related to that in-service injury and/or any other in-service injuries, of record. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is to find against it. If the examiner finds that he/she cannot provide an opinion without resorting to speculation, he/she should explain the inability to provide an opinion. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parrish, Associate Counsel