Citation Nr: 20021118 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 18-15 053 DATE: March 24, 2020 REMANDED Entitlement to service connection for left shoulder condition is remanded. Entitlement to service connection for left elbow condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from July 1977 to October 1977, from January 1989 to April 1989 and from September 2006 to February 2007. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. The undersigned conducted a hearing with the Veteran in January 2020. A transcript of the hearing is in the claims file. 1. Entitlement to service connection for left shoulder condition is remanded. 2. Entitlement to service connection for left elbow condition is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A VA examiner must consider the Veteran’s lay statements regarding the incurrence of a disorder, and his statements regarding the continuity of symptomatology. Dalton v. Nicholson, 21 Vet. App. 23, 39-40. A Veteran is competent to report symptoms that are capable of lay witness observation. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). In October 2014 the Veteran was afforded a VA examination. For the Veteran’s left shoulder condition, the examiner says there is a current disability of acromioclavicular joint osteoarthritis. However, she also notes that Dr. G.H. opined in 2014 that the Veteran “has had a full recovery from his rotator cuff injury” and has no residual sequelae, but that he has nighttime pain when sleeping. See Treatment Records 2014. A different examiner provided a medical opinion in June 2015 based on the October 2014 VA examination, opining the Veteran’s left shoulder condition is less likely than not related to his service. However, the examiner of the medical opinion did not take into consideration the Veteran’s lay statements wherein he reports ongoing symptoms of left shoulder pain since his injury in service, including after his left shoulder surgery. He reported nighttime pain in 2014, as noted in the opinion from Dr. G.H. and the October 2014 VA examination. In January 2020 correspondence he contended that his shoulder is still symptomatic. He also reported left shoulder pain at his 2020 hearing, and says he was recently prescribed physical therapy by his primary care physician. Therefore, this medical opinion is inadequate. The October 2014 VA examination and June 2015 medical opinion also discussed the Veteran’s left elbow condition. The October 2014 examiner diagnosed the Veteran with left triceps tendinitis. She also mentioned the existence of left elbow referred pain from the shoulder, but did not provide a diagnosis. The June 2015 medical opinion examiner opined that the Veteran’s referred pain was not a left elbow condition, because by definition referred pain is “a neurological response from a distant area.” The examiner also opined that the Veteran’s left triceps tendonitis “could not occur 7 years later from an injury that occurred previously as it is an acute use injury and not consistent with the mechanism described.” However, the June 2015 examiner did not take into consideration the Veteran’s lay statements wherein he reports ongoing symptoms of left elbow pain since his injury in service. In his 2020 hearing, he reported elbow pain since his injury in service and said that he is right handed, which he thinks does not explain his tendinitis in his left elbow. He said the implication from his doctors was that tendinitis is from overuse, but he has been overusing his right arm to compensate for the injury to his left arm. Although the examiner determined that referred pain is not an elbow condition, there is no opinion on whether the Veteran’s pain, at any point since his injury, is referred pain or pain related to his tendinitis. Therefore, this medical opinion is inadequate. New opinions based on a full review of the record and supported by stated rationale is needed to fairly resolve the Veteran’s claim. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; Nieves-Rodriguez v. Peake, 22 Vet. App. 295; Dalton v. Nicholson, 21 Vet. App. 23. The matters are REMANDED for the following action: 1. Obtain an addendum opinion to the October 2014 VA examination report and June 2015 medical opinion for the Veteran’s left shoulder condition. The examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s left shoulder condition: i. Had its onset in service, or ii. Is otherwise related to an in-service injury, event, or disease, including relation through continuity of symptomatology. In rendering this opinion, the examiner must consider and address the following: i. Dr. G.H.’s medical opinion wherein the Veteran reports nighttime pain. ii. The October 2014 VA examination wherein the Veteran reports nighttime pain. iii. The January 2020 correspondence wherein the Veteran contends he is still symptomatic. iv. The Veteran’s statements in his 2020 hearing regarding his current pain and his physical therapy treatment recently prescribed by his primary care physician. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. 2. Obtain an addendum opinion to the October 2014 VA examination report and June 2015 medical opinion for the Veteran’s left elbow condition. The examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s left elbow condition, to include referred pain: i. Had its onset in service, or ii. Is otherwise related to an in-service injury, event, or disease, including relation through continuity of symptomatology. In rendering this opinion, the examiner must consider and address the following: i. The Veteran’s statements in his 2020 hearing regarding his left elbow pain since his injury and that he is right handed. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Papacalos, Law Clerk 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.