Citation Nr: 20005522 Decision Date: 01/24/20 Archive Date: 01/22/20 DOCKET NO. 12-28 495 DATE: January 24, 2020 REMANDED The claim for service connection for a right elbow disability, claimed as right elbow injury with residual loss of motion and extension, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1975 to March 1980. The Department of Veterans Affairs is grateful for his service. The claim for service connection for a right elbow disability, claimed as right elbow injury with residual loss of motion and extension, is remanded. The Veteran contends that his current right elbow disability, manifested by loss of motion and extension, is the result of landing on his right elbow when a welding machine landed on his right hand, lacerating fingers and amputating one. The Veteran’s service treatment records reflect the June 1977 injuries and treatments to his right hand. In a January 2018 decision, the Board reopened the previously finally denied claim for service connection for a right elbow disability, claimed as right elbow injury with residual loss of motion and extension. The Board then remanded the claim in January 2018 for a new examination with an opinion addressing the question of etiology of the claimed disability as related to service. The record reflects that the Veteran is homeless and has alcohol use disorder, and that he recently began treatment for his alcohol use disorder with goals of sobriety and stability in housing. The Veteran failed to respond to duty-to-assist letters sent in March and October of 2018 requesting information and authorization to obtain treatment records and failed to appear for an examination scheduled in September 2019 to address his right forearm injury residuals claim. It appears likely that the Veteran did not receive notice of the scheduled examination or was unable to attend related to homelessness or substance use disorder. Notice letters sent to the Veteran were returned as undeliverable. However, recent VA treatment records reflect that the Veteran initiated treatment for alcohol use disorder in November 2019, and he has also sought assistance with stabilizing his housing situation. In light of these efforts, the Board believes that a further opportunity to attend a VA examination is warranted. The matters are REMANDED for the following actions: 1. Obtain and associate with the record all VA treatment records for the Veteran dated from November 2019 to the present. This should include any in-patient hospitalization or treatment for alcohol use disorder. All actions to obtain the requested records should be fully documented in the record. If requested records cannot be located or no such records exist, the Veteran and his representative should be so notified in writing. 2. Once again request that the Veteran provide the names and addresses of any health care providers who have provided treatment for his right elbow and obtain all necessary authorizations. After acquiring this information and authorization, these records should be associated with the claims file. All actions to obtain the requested records should be fully documented in the record. If they cannot be located or if no such records exist, the Veteran and his representative should be so notified in writing. 3. After all additional records are associated with the claims file, again attempt to schedule the Veteran for an appropriate VA examination for a right elbow disability to determine the etiology of his right elbow condition. Inform the Veteran that if he fails to appear for the examination the claim may be denied based on failure to appear for an examination scheduled for a reopened claim for service connection, pursuant to 38 C.F.R. § 3.655(a), (b) (2018). The claims file must be provided to the examiner in conjunction with the examination. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay statements; the examiner must indicate on the examination report that such review was undertaken. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed in addition to those addressed below. The examiner must obtain a full history from the Veteran. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner must provide a fully reasoned explanation. The examiner should state whether there has been a disorder for the Veteran’s right elbow during the appeal period. For any identified right elbow disorder, the examiner must provide an opinion whether it is at least as likely as not (50 percent or greater probability) that such disability was either developed in service or is otherwise causally related to service. The examiner should reconcile any opinion with the evidence of record and cite to the record as appropriate. Also, the examiner should not resort to mere speculation, but rather should consider that the phrase “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 certain conclusion as it is to find against it. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2011). (Continued on the next page)   A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, readjudicate the claim on appeal. If the benefit sought remains denied, provide a supplemental statement of the case to the Veteran and his representative. After the Veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. L. CHU Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Schechter The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.