Citation Nr: 21002873 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 09-23 054A DATE: January 19, 2021 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to July 1971, from March 1973 to February 1979, and from October 1984 to February 1985. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2007 rating decision. In March 2017, the Board denied the Veteran’s claims of entitlement to service connection for bilateral shoulder disabilities. The Veteran appealed this denial to the United States Court of Appeals for Veterans Claims (Court). In October 2017, the Court granted a Joint Motion for Partial Remand (JMPR) filed by the Veteran and Secretary of VA (parties), vacating the Board denial and remanding the claims back to the Board. Since that JMPR was granted, this matter has been before the Board in December 2017 and January 2019, resulting in remands each time for additional development. In the January 2019 remand, the Board found that a March 2018 VA examination failed to provide adequate medical opinions for adjudication purposes, as the examiner failed to provide sufficient rationale addressing whether the Veteran’s shoulder disabilities have been aggravated by his service-connected cervical spine disability. The matter was remanded to obtain an addendum opinion from the March 2018 examiner, if available, or from another appropriate clinician. In June 2019, new medical opinions were provided based on the evidence in the Veteran’s file by an examiner who had not previously examined him. The examiner opined that the Veteran’s shoulder disabilities were not at least as likely as not proximately due to the service-connected cervical spine disability because arthritis in one joint cannot pathophysiologically cause arthritis in another joint. While referred pain from the neck to the shoulders is possible, the examiner explains that it cannot cause arthritis in the shoulder joints. She further noted that an EMG performed previously found no radiculopathy, but rather specific bilateral carpal tunnel syndrome. With regard to aggravation, the examiner stated that the Veteran’s shoulder conditions are less likely than not aggravated beyond their natural progression by the cervical spine disability, though the only rationale provided was that there is no available evidence to support a baseline of severity or show that aggravation has occurred. When VA undertakes to obtain an examination, it must ensure the provided examination and opinions are adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (overruled on other grounds, Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013)). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). In this case, the Board finds the June 2019 medical opinions are inadequate to allow the Board to proceed with adjudication of the Veteran’s claims. The examiner’s rationale for why the Veteran’s shoulder arthritis is not proximately due to his cervical spine disability is not responsive to the contentions raised by the Veteran and his representative. As noted in the September 2020 brief submitted by the Veteran, he does not contend that his neck arthritis spread to his shoulder or was otherwise physiologically caused the shoulder arthritis; rather, he contends that favoring his cervical spine due to his disability has caused him to “overwork” his shoulders, accelerating the progression of his bilateral shoulder disabilities. Furthermore, with regard to aggravation, the examiner has provided no substantive supporting rationale for her opinion that the shoulder disabilities have not been aggravated by the Veteran’s cervical spine disability. In stating there is no evidence to establish a baseline for the severity of the Veteran’s disability or show aggravation, the examiner provides no explanation that would allow the Board to assess the credibility of this opinion in light of the Veteran’s medical history or the other evidence of record. For these reasons, the Board finds that another remand is unfortunately required to obtain a new medical opinion. The matters are REMANDED for the following action: Obtain a new medical opinion regarding the nature and etiology of the Veteran’s bilateral shoulder disabilities. The Veteran should only be scheduled for a new examination if deemed necessary by the selected examiner. The examiner must provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral shoulder disabilities were either caused or aggravated by his service-connected cervical spine disability. The examiner should recognize that the question of aggravation is separate from the question of causation and is a question that the Board is required to address in the context of the Veteran’s secondary service connection claim. The opinion must explicitly address both causation and aggravation, and provide adequate rationale for each, to be deemed adequate. The examiner is advised aggravation means the service-connected disability caused an increase in the severity of an existing nonservice-connected disability beyond the natural progression of the disease. If aggravation is found, the examiner must attempt to establish the baseline level of severity of the shoulder disabilities prior to aggravation by the service-connected disability. If the examiner is unable to establish a baseline for the shoulder disabilities prior to the aggravation, he or she should state such and explain why a baseline cannot be determined. In the context of the opinion, the examiner must address the Veteran’s contention that progression of his shoulder disabilities has been accelerated by altered use of these joints to compensate for his cervical spine disability. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide a reason for doing so. The fact that his report of symptoms is not corroborated by contemporaneous medical treatment records is not, by itself, a sufficient reason to reject the Veteran’s report of symptoms capable of lay observation. The examiner is further advised that it is not necessary for pain to attributable to a specific diagnosis or pathology to be considered a service-connected disability so long as the pain is productive of functional impairment. To the extent the record shows shoulder pain productive of functional impairment prior to the initial diagnosis of the Veteran’s shoulder arthritis, the examiner should address this pain in the provided opinion and whether it is caused or aggravated by the service-connected cervical spine disability. The examiner’s report must include a complete rationale for the opinion provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Pitman, Associate 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.