Citation Nr: 21001976 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 200928-111728 DATE: January 12, 2021 REMANDED Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from March 1967 to September 1977. A March 2020 AMA rating decision denied service connection for, in pertinent part, a left shoulder disability. In a May 2020 VA Form 20-0996, the Veteran requested higher level review (HLR) of the March 2020 rating decision. A May 2020 HLR decision considered the evidence of record at the time of the March 2020 rating decision and continued the denial of the claim. In his September 2020 VA Form 10182 (Notice of Disagreement and Appeal to the Board) the Veteran appealed the May 2020 decision and chose the Direct Review lane. Therefore, the Board may only consider the evidence of record at the time of issuance of the March 19, 2020 rating decision (as HLR was limited to what was of record in March 2020). A separate Board decision addresses claims of service connection for posttraumatic stress disorder, bilateral hearing loss, tinnitus, cervical spine spondylosis, obstructive sleep apnea, and a right shoulder disability. This decision serves as a supplement to that decision due to an inadvertent omission of the adjudication of the issue addressed herein. Entitlement to service connection for a left shoulder disability. VA must provide a medical examination or obtain a medical opinion when there is: (1) competent evidence of a current disability (or persistent or recurrent symptoms of a disability); (2) evidence that an event, injury or disease occurred in service; (3) an indication that the current claimed disability or symptoms may be associated with service; and (4) there is not sufficient medical evidence to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The record does not contain a competent medical opinion addressing whether the Veteran’s claimed left shoulder disability is etiologically related to his service. He was not afforded a VA examination in this matter. Regarding whether he has a current left shoulder disability, while medical evidence of record does not show such disability, the Veteran’s claim for service connection states that he has a bilateral shoulder disability due to arthritis related to service and from exposure to radiation from doing heart catheterizations [in service]. The Veteran is a physician (cardiologist). Therefore, he is considered competent to opine on medical issues (as opposed to a layperson with no medical training). The Board finds the Veteran’s contentions, while insufficient to establish a diagnosis of a left shoulder disability, is competent evidence bearing on the existence of a current disability. The first element under McLendon is met. That he was exposed to radiation performing heart catheterizations is consistent with his duties as a cardiologist in service (and the Board finds no reason to question his assertion that such procedure involved exposure to radiation; it is not contradicted by competent evidence in the record). The Board finds the Veteran’s account is evidence establishing that an etiological event occurred in service, satisfying the second criterion under McLendon. Based on his training in medicine, his assertion of etiology is sufficient to meet the low threshold standard for determining the claimed left shoulder disability may be to the event in service. Thus, the third element of McLendon is met, and a VA examination and/or opinion are necessary to adjudicate the claim. The Board finds that the failure to obtain an adequate opinion regarding the likely etiology of the claimed left shoulder disability under these circumstances constitutes a pre-decisional duty to assist error, which requires correction. The matter is REMANDED for the following: Arrange for the Veteran to be examined by an appropriate clinician to determine the nature and likely etiology of his claimed left shoulder. The Veteran’s record must be reviewed by the examiner in conjunction with the examination. On review of the record and interview/examination of the Veteran, the examiner should: (a) Identify (by diagnosis) each left shoulder disability found. (b) Identify the likely etiology of the diagnosed left shoulder disability. Is it at least as likely as not (a 50 percent or greater probability) that the disability was incurred in service? If not identify the etiology that is considered to be more likely. All opinions must include an explanation of rationale, with citation to medical principles and supporting factual data. The rationale must address the contention that a left shoulder disability was caused by exposure to radiation from heart catheterizations in service. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Baker, Counsel 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.