Citation Nr: 19123772 Decision Date: 03/29/19 Archive Date: 03/29/19 DOCKET NO. 15-39 942 DATE: March 29, 2019 REMANDED Entitlement to service connection for a cervical spine disorder is remanded. Entitlement to service connection for a left arm disorder, to include arthritis and radiculopathy, is remanded. Entitlement to service connection for a left shoulder disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1981 to October 1990, with additional Reserve service. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a Board hearing in his Form 9 substantive appeal; however, he withdrew his request in July 2016.   1. Entitlement to service connection for a cervical spine disorder is remanded. 2. Entitlement to service connection for a left arm disorder, to include arthritis and radiculopathy, is remanded. 3. Entitlement to service connection for a left shoulder disorder is remanded. The Veteran initially filed claims of service connection for left arm arthritis and a left shoulder nerve condition. He later clarified that he was seeking service connection for a cervical spine disorder with radiating pain into the left arm secondary to the cervical spine disorder. The Veteran contends that his neck, left arm, and left shoulder disorders are due to lifting patients as a medical service technician during active service. Treatment records from 2011 reflect the Veteran’s report of an in-service injury due to heavy lifting with chronic, intermittent neck and left arm pain since. See 10/19/2011, Medical-Government. He also contends that his disorders are proximately related to his service-connected disabilities, to include due to long-term steroid use. A July 2013 VA examination included diagnoses of degenerative disc disease and degenerative joint disease of the cervical spine and indicated the presence of radicular symptoms of the left arm. The Veteran was not afforded VA examinations to determine whether there are other current disorders of the left arm and left shoulder. The Agency of Original Jurisdiction (AOJ) should therefore schedule the Veteran for VA examinations to determine the nature and etiology of any current disorders of the cervical spine, left arm, and left shoulder. The matters are REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from October 2017 to the present. 2. After completing directive #1, obtain an opinion from an appropriate VA clinician regarding the nature and etiology of the Veteran’s cervical spine disorder. An in-person examination is not required unless deemed necessary by the clinician. The clinician should review the virtual file. The clinician should address the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that a current cervical spine disorder manifested during or is otherwise related to the Veteran’s period of active service, to include due to lifting patients in service. (b.) Whether it is at least as likely as not (50 percent or greater probability) that arthritis of the cervical spine (i) manifested to a compensable degree within one year of October 19, 1990, or (ii) was noted during service with continuity of the same symptomatology since service. In responding to (a) and (b), the clinician should consider and address (i) the in-service neck injury; (ii) treatment records reflecting the Veteran’s report of an in-service injury due to heavy lifting with chronic, intermittent neck and left arm pain since; and (iii) the Veteran’s contention that a current cervical spine disorder is due to lifting patients during service. (c.) Whether it is at least as likely as not (50 percent or greater probability) that a current cervical spine disorder is proximately due to a service-connected disability, to include due to long-term steroid use. (d.) Whether it is at least as likely as not (50 percent or greater probability) that a current cervical spine disorder has been aggravated (i.e., worsened beyond the normal progression of that disease) by a service-connected disability, to include due to long-term steroid use. A rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the clinician relies on medical or scientific literature to support an opinion, he or she should identify said literature. 3. After completing directive #1, schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of any current disorder of the left arm. The clinician should review the virtual file. The clinician should address the following: (a.) Identify all disorders of the left arm that are currently present (or present any time from July 27, 2011, to the present). Specifically, state whether arthritis is present, which may require conducting diagnostic testing. If the examiner disagrees with a diagnosis already established in the medical records, he/she should so state and explain why. (b.) Whether it is at least as likely as not (50 percent or greater probability) that a current left arm disorder manifested during or is otherwise related to the Veteran’s period of active service, to include due to lifting patients in service. (c.) If arthritis of the left arm is diagnosed, is it at least as likely as not (50 percent or greater probability) that it (i) manifested to a compensable degree within one year of October 19, 1990, or (ii) was noted during service with continuity of the same symptomatology since service? In responding to (b) and (c), the clinician should consider and address (i) treatment records reflecting the Veteran’s report of an in-service injury due to heavy lifting with chronic, intermittent neck and left arm pain since; and (ii) the Veteran’s contention that a current left arm disorder is due to lifting patients during service. (d.) Whether it is at least as likely as not (50 percent or greater probability) that a current left arm disorder is proximately due to a service-connected disability, to include due to long-term steroid use. (e.) Whether it is at least as likely as not (50 percent or greater probability) that a current left arm disorder has been aggravated (i.e., worsened beyond the normal progression of that disease) by a service-connected disability, to include due to long-term steroid use. A rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the clinician relies on medical or scientific literature to support an opinion, he or she should identify said literature. 4. After completing directive #1, schedule the Veteran for an examination with an appropriate clinician to determine the nature and etiology of any current disorder of the left shoulder. The clinician should review the virtual file. The clinician should address the following: (a.) Identify all disorders of the left shoulder that are currently present (or present any time from July 27, 2011, to the present). If the examiner disagrees with a diagnosis already established in the medical records, he/she should so state and explain why. Even if there is no diagnosed disorder, pain resulting in functional impairment may constitute a disability for service-connection purposes. If present, describe any functional impairment; if not, state why. (b.) Whether it is at least as likely as not (50 percent or greater probability) that a current left shoulder disorder manifested during or is otherwise related to the Veteran’s period of active service, to include due to lifting patients in service. (c.) If arthritis of the left shoulder is diagnosed, is it at least as likely as not (50 percent or greater probability) that it (i) manifested to a compensable degree within one year of October 19, 1990, or (ii) was noted during service with continuity of the same symptomatology since service? In responding to (b) and (c), the clinician should consider and address (i) treatment records reflecting the Veteran’s report of an in-service injury due to heavy lifting with chronic, intermittent neck and left arm pain since; and (ii) the Veteran’s contention that a current left shoulder disorder is due to lifting patients during service. (d.) Whether it is at least as likely as not (50 percent or greater probability) that a current left shoulder disorder is proximately due to a service-connected disability, to include due to long-term steroid use. (e.) Whether it is at least as likely as not (50 percent or greater probability) that a current left shoulder disorder has been aggravated (i.e., worsened beyond the normal progression of that disease) by a service-connected disability, to include due to long-term steroid use. A rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page)   If the clinician relies on medical or scientific literature to support an opinion, he or she should identify said literature. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.A. Gelber, Associate Counsel