Citation Nr: 21004472 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 14-41 803 DATE: January 27, 2021 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left hip disability is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1982 until July 1992. These matters come to the Board of Veterans’ Appeals (Board) on appeal from September 2013 and February 2014 Department of Veterans Affairs (VA) regional office (RO) rating decisions. In a June 2018 decision, the Board, inter-alia, denied entitlement to service connection for the above disabilities. The Veteran appealed these denials to the Court of Appeals for Veterans Claims (Court). In a January 2020 memorandum decision, the Court set aside the portion of the decision related to the above claims. The Court explained that the Board’s June 2018 decision contained an inadequate statement of reasons and bases for denying these claims as it failed to address whether the Veteran was entitled to a VA examination. In August 2020, the Board remanded these claims for VA examination consistent with the Court’s memorandum decision. These claims return to the Board for further adjudication. REASONS FOR REMAND The Board finds that the issues of entitlement to service connection for a right shoulder disability, cervical spine disability, left knee disability, and left hip disability must be remanded for further development. 1. Entitlement to service connection for a right shoulder disability Regarding the right shoulder VA examination, the Veteran reported onset in 1991 after being tackled playing flag football and having pain in that joint ever since. See also May 2020 CAPRI Records. The VA examiner noted that the Veteran’s right shoulder disability has progressed since onset, however, she opined that it was less likely than not related to service as there were no “continued complaints and treatment for such.” The Board finds this rationale internally inconsistent—either the Veteran’s right shoulder disability had its onset in service after playing flag football and worsened since then, or it did not. For this reason, addendum opinion is necessary for further explanation. The Board notes that in a May 2012 lay statement, the Veteran explained that he stated that he was taken to the clinic, but the attending physician sent him away with “pain pills.” A September 2013 buddy statement indicates that the Veteran reported that it felt like his shoulder had “popped out and back in.” On remand, this information must be specifically considered. 2. Entitlement to service connection for a cervical spine disability Regarding the cervical spine disability, the August 2020 Board directives asked the VA examiner to opine whether it was caused or aggravated by a right shoulder disability. Instead of answering this question, the VA examiner opined that the cervical spine disability was not aggravated beyond its normal progression by service. As the VA examiner failed to address the proper question presented by the Board, remand is necessary. Stegall v. West, 11 Vet. App. 268 (1998). Furthermore, two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered. Because a decision on the Veteran’s right shoulder claim could significantly impact a decision on the cervical spine issue, the issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined cervical spine claim is therefore required for this reason as well. 3. Entitlement to service connection for a left knee disability 4. Entitlement to service connection for a left hip disability The August 2020 VA examiner solely provided opinions regarding whether the Veteran’s left knee and left hip disabilities were caused or aggravated by his service-connected left ankle disability. The examiner opined that the left knee was not caused or aggravated by the service-connected ankle disability because there was no left ankle instability, and because of the Veteran’s reports that he suffered his knee injury after playing basketball. The examiner additionally opined that the left hip disability was not caused or aggravated by the service-connected ankle disability as the Veteran’s gait was deemed normal, there is no ankle instability, and because these type of injuries are common on the contralateral – and not the same – side. Subsequently, in November 2020, additional VA treatment records were added to the claims file. Therein, May 2020 treatment records show that the Veteran reported that his left knee and left hip disabilities were injured in service and that he “continues to have chronic pain” since separation. The Board notes that there is lay evidence suggesting that the Veteran sustained lower body injuries during a 1987 softball game. Given that this additional evidence suggests that the Veteran’s left knee and left hip disabilities are directly related to service, remand is necessary for an addendum medical opinion. These matters are REMANDED for the following action 1. Obtain any outstanding VA or private medical records. 2. Obtain addendum VA medical opinions from an appropriate examiner to assess the nature and etiology of the Veteran’s right shoulder, cervical spine, left knee, and left hip disabilities. An in-person examination (or telehealth interview or similar action, if an in-person examination is not feasible) need not be scheduled unless it is deemed necessary by the examiner or otherwise required by the evidence. The examiner must review the claims file in its entirety and that review should be noted in the examination report. The examiner is requested to provide separate, fully articulated medical opinions with respect to the following: (a) Whether it is at least as likely as not that the Veteran’s right shoulder disability began in or is otherwise related to service, to include a Fall 1991 flag football injury? In rendering this opinion, the VA examiner must consider and discuss the Veteran’s lay reports that he has had pain in his right shoulder ever since the injury, the September 2013 buddy statement describing the injury, and the March 2012, March 2013, and May 2020 VA treatment records. The VA examiner is also asked to address the August 2020 examiner’s note that the Veteran’s right shoulder disability has worsened since onset in 1991. (b) Whether it is at least as likely as not that the Veteran’s cervical spine disability had its onset in service, or is otherwise related to service, to include the 1991 flag football injury? (c) If the VA examiner finds that the Veteran’s right shoulder disability is etiologically related to service: a. Whether it is at least as likely as not that the Veteran’s cervical spine disability was caused by his right shoulder disability? b. Whether it is at least as likely as not that the Veteran’s cervical spine disability was aggravated (any incremental increase in the diabetes beyond its normal progression) by his right shoulder disability? (d) Whether it is at least as likely as not that the Veteran’s left knee disability onset in service or is otherwise etiologically related to service, to include a 1987 softball game injury? The VA examiner must address the May 2020 VA treatment records where the Veteran reported that his left knee disability onset in service and has continued to have chronic pain. The VA examiner must also address the August 2020 VA examiner’s finding that the Veteran injured his left knee playing basketball in 2010. (e) Whether it is at least as likely as not that the Veteran’s left hip disability onset in service, within a year of service, or is otherwise related to service, to include a 1987 softball game injury? The VA examiner must address the May 2020 VA treatment records where the Veteran reported that his left hip disability onset in service and has continued to have chronic pain since. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Finelli, 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.