Citation Nr: 21003633 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 14-29 249A DATE: January 22, 2021 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right elbow disability, to include residuals from radial head fracture, is remanded. Entitlement to service connection for a left thumb disability is remanded. REASONS FOR REMAND The Veteran served in the Air Force Reserves from June 1985 to 2008, with various periods of qualifying service. This matter comes on appeal before the Board of Veterans’ Appeals (Board) from a June 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). As an initial matter, the Veteran’s August 2014 VA Form 9 specifically appealed the claims for neck and bilateral shoulder disabilities and attached was a copy of the March 2012 notice of disagreement which included the claims for right elbow and left thumb disabilities. In addition, the Veteran has stated in a subsequent VA Form 9 her belief that the right elbow and left thumb disabilities should be considered. See VA Form 9 dated May 3, 2020. As the Veteran believed all issues were appealed, the Board will address the claims for service connection of the right elbow and left thumb disabilities. See Percy v. Shinseki, 23 Vet. App. 37, 47 (2009) (the Board is required to address all claims reasonably raised in the appellant’s substantive appeal and in all of his or her documents and oral testimony submitted prior to the Board’s decision). The Board notes further that the RO granted service connection for a neck disability in a June 2014 rating decision; that award is a complete grant of the benefit sought. Te Veteran’s service connection claims for ear infection, bronchitis, asthma, endometriosis, tinnitus, and hearing loss, remain pending as the Veteran requested a Board hearing on her May 2020 VA Form 9. As a result, those claims will not be addressed in this decision. Right Shoulder The Veteran asserts that her right shoulder disability is the result of an August 1987 motor vehicle accident (MVA) during which her vehicle struck a guardrail. See correspondence to VA dated April 14, 2014. The medical records associated with the August 1987 accident reflect that the Veteran was taken to the emergency room at the Naval hospital in Pensacola, Florida. A Line of Duty determination indicates that the accident was incurred during a period of inactive duty for training. See Line of Duty Determination dated August 2, 1987. The Veteran was afforded a VA compensation examination in March 2011 and the examiner diagnosed degenerative joint disease of the acromioclavicular joint in the right shoulder, but opined that that the disability was less likely as not related to service. The examiner essentially reasoned that there were no complaints noted in the Veteran’s service treatment records (STRs). The Board finds the March 2011 VA opinion inadequate and therefore a new opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). First, the opinion appears to be based solely on the lack of right shoulder complaints in the STRs, which is impermissible. Indeed, the Veteran’s lay contentions regarding onset must be considered. In this regard, the examiner did not address the Veteran’s statement that she injured her right shoulder during the August 1987 MVA, or her report that she fell down the stairs in 2004. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (finding that examination was inadequate where the examiner did not comment on the appellant’s report of in-service injury and instead relied on the absence of evidence in the service medical records to provide a negative opinion). Therefore, on remand, an adequate etiology opinion must be obtained. Left Shoulder The Veteran asserts that her currently diagnosed left shoulder disability is also the result the aforementioned August 1987 MVA. She states that during the MVA, her left shoulder struck the driver-side window. Naval hospital emergency department records reflect that the Veteran was diagnosed with soft tissue trauma of the left shoulder after the August 1987 MVA. See Emergency Care and Treatment dated August 2, 1987. As indicated, a Line of Duty determination found the injury was incurred during a period of inactive duty for training. See Line of Duty Determination dated August 2, 1987. The Veteran was afforded a VA compensation examination in March 2011. The examiner opined that the claimed left shoulder disability was less likely as not related to service. The examiner noted the diagnosis from the accident was soft tissue trauma of the left shoulder and found that the Veteran’s service treatment records (STRs) and claim file contained no other complaints related to the left shoulder. The examiner concluded that, despite subjective complaints by the Veteran, there was no objective evidence to support a diagnosis of the left shoulder and thus no etiology opinion was provided. See VA examination and opinion, dated March 2, 2011. More recently however, the Veteran has been diagnosed in September 2017 with impingement syndrome of the left shoulder as well as degenerative joint disease of the left acromioclavicular joint. Moreover, the Veteran underwent two surgeries on her left shoulder, one to repair a longitudinal tear of the supraspinatus tendon to treat; another to repair the rotator cuff. See Id.; Operative Summary dated, March 13, 2018. Hence, a current disability of the left shoulder is shown. Given the current left shoulder disabilities, the in-service MVA, and the Veteran’s contentions, a new etiology opinion must be obtained. Right Elbow The Veteran asserts that she has a right elbow disability that is the result of an injury sustained while playing basketball on September 8, 1985. A review of the Veteran’s military personnel records indicated the Veteran was on “Active Duty Other” on the date of the injury. The March 2011 VA examiner opined that the Veteran’s right radial head fracture was as likely as not caused by or related to service or a service-connected disability. However, the examiner found no evidence of a current right elbow disability, noting that the radial head fracture had healed and there were no signs of fracture or dislocation on x-rays. See VA examination and opinion dated March 2, 2011. The Board finds the opinion confusing and as such must remand the claim for clarification. While the examiner opined that the Veteran’s right elbow injury in service had resolved and that she currently has no right elbow disability, the examiner provided a favorable etiology opinion as to the claimed disability. On remand, the examiner should determine whether the Veteran’s current right elbow symptoms result in functional impairment of earning capacity and if so, whether the current impairment is related to service; indeed, she has reported being unable to straighten her arm and having pain on movement and swelling in her right elbow. See VA Form 9, dated May 3, 2020. Left Thumb The Veteran asserts that she has a left thumb disability that is related to an injury sustained while skiing in Utah in April 1990. A review of the Veteran’s military personnel file shows she was on a “special tour” from April 8 to April 14, 1990. She was diagnosed with, and received treatment for, gamekeeper’s thumb in April and May 1990. See e.g. Chronological Record of Medical Care dated May 17, 1990. She relates the skiing injury to her current left thumb pain, swelling and limited motion. On remand, the RO should clarify whether the Veteran’s duty status during the April 1990 “Special Tour” was considered active duty, inactive duty for training or active duty for training. In addition, a VA examination and medical opinion should be obtained to determine whether any current disability is related to an incident incurred during the April 1990 “special Tour” period. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Review the Veteran’s service personnel records and clarify whether the Veteran’s “Special Tour” duty on April 12, 1990, was a period of active duty, inactive duty for training, or active duty for training. 2. Then, obtain another medical opinion to clarify the etiology of the Veteran’s right shoulder and left shoulder disabilities. The claims file and a copy of this Remand will be made available to the examiner, who will acknowledge receipt and review of these materials. After a review of the claims file, the examiner is asked to respond to the following: (a) Clearly indicate all current diagnoses of the right and left shoulders. (b) For each current right shoulder disability, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) related to an injury incurred during the August 1987 MVA. In doing so, consider (i) the Veteran’s statement that the MVA was the onset of her current right shoulder problems, and (ii) any impact that a June 2004 work-related injury (falling down a set of stairs injuring her right shoulder and back) has on the current shoulder disability. (c) For each current left shoulder disability, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) related to the soft tissue injury to the left shoulder resulting from the August 1987 MVA would result in any of the diagnosed left shoulder disabilities. 3. Provide the Veteran with a VA examination to ascertain the current nature and etiology of claimed right elbow disability. (a) Clearly indicate whether the Veteran currently has had any residuals of right radial head fracture or residual symptoms resulting in functional impairment of earning capacity at any time during the appellate period. In doing so, specifically address the Veteran’s lay statements regarding swelling and loss of range of motion in the elbow joint. (b) For any current right elbow disability or symptoms resulting in functional impairment, provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) related to a qualifying period of service, including in September 1985 while playing basketball. 4. Provide the Veteran with a VA examination to ascertain the current nature and etiology of claimed left thumb disability. (a) Clearly indicate whether the Veteran currently has had a left thumb disability or any symptoms resulting in functional impairment in earning capacity at any time during the appellate period, and if so, provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) related to the April 1990 skiing injury while on “Special Tour.” Address the April/May 1990 diagnosis of gamekeeper’s thumb. A complete rationale should be provided for all opinions. 4. Thereafter, readjudicate the remanded claims. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Moldawer, 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.