Citation Nr: 21004278 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 16-07 182 DATE: January 26, 2021 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from July 1997 to July 2001. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). These matters were remanded Board in February 2020 for additional development, to include VA examinations. These matters have now returned to the Board for appellate consideration. 1. Entitlement to service connection for a right shoulder disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. The Veteran has diagnoses of left knee patellofemoral pain syndrome and right shoulder strain. Therefore, the first element of service connection is met for both issues. He asserts that his shoulder disability is due to overcompensation from his service-connected left shoulder disability. The Board finds the Veteran competent and credible to describe increased use of his right shoulder. Additionally, his service treatment records show left knee pain. The Veteran underwent examinations for his disabilities following the February 2020 Board remand. Concerning his right shoulder disability, the examiner provided a negative direct nexus opinion as his pain started in 2012 and there was no evidence of an injury in service. The examiner also provided a negative secondary opinion finding that there was no evidence of treatment in the records and it was not proximately due to or aggravated by any service-connected disabilities. However, the Board finds that the examiner did not sufficiently address whether the Veteran’s overcompensation due to his service-connected left shoulder disability proximately caused or aggravated his current right shoulder disability. Additionally, a negative nexus opinion was provided for his left knee disability. The examiner stated that his in-service knee pain was acute, and that there was no evidence of pain from 2008 (when he had an x-ray) until 2020. However, the examiner appears to have insufficiently considered medical records from July 2009 that reported chronic left knee pain. This undercuts the rationale of no evidence of pain from 2008 until 2020. As such, the Board finds that additional addendums or examinations are warranted for both disabilities on appeal. These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. All requests and responses for the records must be documented. If any identified records cannot be obtained, notify the Veteran of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow him an opportunity to provide the missing records. 2. After associating any treatment records with the claims file, obtain an addendum opinion or schedule the Veteran for an appropriate examination to determine the etiology of the Veteran’s right shoulder disability if necessary. The claims file is to be made available to the examiner and reviewed. -- Then, regarding the Veteran’s right shoulder disability, address whether: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s right shoulder disability was either 1) proximately due to OR 2) aggravated by any service-connected disability, to include his service-connected left shoulder disability? ** Please note and address the Veteran’s contention that his right shoulder disability was caused by overcompensation due to his service-connected left shoulder disability. The Board has found the Veteran competent and credible to describe overcompensating with his right shoulder due to his service-connected left shoulder, and the examiner must explicitly consider his competent lay statement(s) in forming a nexus opinion.** 3. After associating any treatment records with the claims file, obtain an addendum opinion or schedule the Veteran for an appropriate examination to determine the etiology of the Veteran’s left knee disability if necessary. The claims file is to be made available to the examiner and reviewed. -- Then, address whether: (a.) Is it at least as likely as not (50 percent or greater probability) that his disability is related to an in-service injury, event, or disease, to include his reported left knee pain in service? See 3/11/2015, STR – Medical – Knee. (b.) If not, is it at least as likely as not (50 percent or greater probability) that the Veteran’s disability is either 1) proximately due to OR 2) aggravated by the Veteran’s service-connected disabilities? The term “aggravated” refers to a worsening of the underlying condition beyond the natural progression of the disease, as opposed to temporary or intermittent flare-ups or symptoms that resolve with return to the baseline level of disability. If aggravation is found, please state, to the extent possible, the baseline level of disability prior to aggravation. A comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. (Continued on the next page)   If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Garrett Morales, 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.