Citation Nr: 21003592 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 11-10 098 DATE: January 22, 2021 RE MANDED Entitlement to service connection for acromegaly with osteoarthritis of the body is remanded. Entitlement to service connection for a left hip disability as secondary to acromegaly is remanded. Entitlement to service connection for a right hip disability as secondary to acromegaly is remanded. Entitlement to service connection for a left shoulder disability as secondary to acromegaly is remanded. Entitlement to service connection for a right shoulder disability as secondary to acromegaly is remanded. REASONS FOR REMAND The Veteran had active military service from September 1965 to July 1967. He was awarded a Purple Heart Medal and Combat Infantryman’s Badge among his awards and decorations. The Veteran and his son testified before the Board at an October 2015 hearing conducted at the Regional Office. A transcript of the hearing is of record. The Board notes that this appeal has a rather lengthy procedural history. Most recently, in December 2017, the Board denied the Veteran’s appeal. A June 2020 Court of Appeals for Veterans Claims (Court) Memorandum Decision vacated the Board’s December 2017 decision. The appeal has since been returned to the Board for further consideration. 1. Entitlement to service connection for acromegaly with osteoarthritis of the body is remanded. 2. Entitlement to service connection for a left hip disability as secondary to acromegaly is remanded. 3. Entitlement to service connection for a right hip disability as secondary to acromegaly is remanded. 4. Entitlement to service connection for a left shoulder disability as secondary to acromegaly is remanded. 5. Entitlement to service connection for a right shoulder disability as secondary to acromegaly is remanded. As discussed above, in June 2020, the Court issued a Memorandum Decision, vacating and remanding the appeal for additional action. Specifically, the Court found that the Board failed to fully satisfy the duty to assist. In this regard, the Court found that the VA opinions relied on by the Board were inadequate. The January 2017 examiner did not use the correct standard for aggravation in assessing the Veteran’s condition. The examiner opined that “[t]he objective evidence fails to support the acromegaly [was] aggravated by active duty service.” However, the standard in this case is whether there is clear and unmistakable evidence, either that the condition did not increase in disability during service or that any increase was due to the natural progress of the disease or injury. See 38 U.S.C. § 1153 (2012); Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). The January 2017 examiner also seemed to make a credibility determination regarding the Veteran’s statements that he did not play sports or engage in strenuous exercise prior to service by noting that he went fishing and skeet shooting. See Owens v. Brown, 7 Vet. App. 429, 433 (1995) (It is the responsibility of the Board, not the examiner, “to assess the credibility and weight to be given to evidence.”). Particularly, the examiner focused on non-service activities that may have contributed to the Veteran’s joint problems, but did not explain why his service could not have also aggravated his condition beyond its natural progression. The Court then found that the August 2017 examiner also did not provide an adequate medical opinion. Although the examiner applied the correct standard, the examiner focused on whether the Veteran physically grew during service without opining as to any of the other aspects of his condition, including joint pain during service and the effects of strenuous exercise on his condition. Without an opinion that fully addresses these issues, the Court determined that the Board’s December 2017 decision is not supported by the evidence or adequate reasons or bases. As such, the appeal is remanded in order to obtain an addendum opinion correcting the inadequacies described in the Court’s June 2020 Memorandum Decision . The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate VA examiner for an addendum opinion regarding the claimed acromegaly with osteoarthritis of the body, bilateral hip and shoulder disabilities. If the examiner believes an additional physical examination of the Veteran would be beneficial, one is to be arranged. The entire claims file must be made available to the examiner for review. All appropriate tests and studies should be conducted, and any consultations deemed necessary should be accomplished. After reviewing the record and examining the Veteran (if deemed necessary), the examiner should provide an opinion regarding the following: (a) Does the evidence of record clearly and unmistakably (i.e., it is undebatable) show that the Veteran suffered from acromegaly prior to his entry into active service? (b) If the answer to (a) is yes, does the evidence of record clearly and unmistakably (i.e., it is undebatable) show that the preexisting acromegaly was not aggravated by service or that any increase in disability was due to the natural progression of the disorder? Please identify the nature of the condition that preexisted service and identify and discuss in detail the evidence relied upon in reaching these conclusions. The Veteran’s claimed joint pain during service and the effects of strenuous exercise on his condition should also be discussed when determining aggravation. (c) If the answer to either (a) or (b) is no, presuming the Veteran sound at service entry, is it at least as likely as not (probability of at least 50 percent) that the Veteran’s acromegaly had its onset or is otherwise etiologically related to his active service? (d) If it is determined that the Veteran’s acromegaly is related to service in any way, also offer an opinion as to whether it is at least as likely as not (probability of at least 50 percent) that the Veteran’s current bilateral hip and/or shoulder disabilities were either caused or aggravated (chronically worsened beyond normal progression) by his acromegaly. A complete rationale must be provided for all opinion(s) should be expressed. All prior reports should be reconciled, as necessary. 2. After the development requested has been completed, the Agency of Original Jurisdiction (AOJ) should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Miller, 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.