Citation Nr: 21004516 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 12-27 420A DATE: January 27, 2021 REMANDED Entitlement to service connection for right shoulder disability, to include as secondary to service-connected left hip, knee, and ankle disabilities, is remanded. Entitlement to service connection for left shoulder disability to include as secondary to service-connected left hip, knee, and ankle disabilities, is remanded. REASONS FOR REMAND The Veteran has active service from October 1966 to March 1967. This case is before the Board of Veterans’ Appeals (Board) from a November 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans’ Law Judge at a November 2016 hearing. In June 2017 and September 2020, the Board remanded these matters to the RO for additional development. While the requested examinations have been obtained, the opinions are not sufficient for the Board to rely upon in rendering a decision in this matter. While the Board regrets further delay in the Veteran’s claim, additional remand is necessary. The Veteran has claimed service connection for a right and left shoulder disabilities (8/30/2011 VA 21-4138 Statement In Support of Claim). The Veteran contends his shoulder disabilities are secondary to left leg, hip and foot conditions. He is forced to walk with a cane or walker, relying on his upper body strength to ambulate, placing stress on his shoulders (10/07/2013 NOD; 11/01/2016 Hearing Transcript, pg. 13). Addendum opinions were obtained in November 2020, pursuant to the last remand. In rendering the opinions, the examiner did not address the Veteran’s contention that the use of a cane or walker, due to his service-connected disabilities of his lower extremity, caused left or right shoulder disability or aggravated any shoulder disabilities beyond their normal progression. The matters are REMANDED for the following action: Forward the claims file to a qualified and appropriate clinician for an addendum opinion consistent with this remand. If the following cannot be addressed without an in-person examination, an examination should be scheduled. The examiner is requested to render an opinion as to whether it is at least as likely as not (i.e., a likelihood of 50 percent or more) that any currently diagnosed shoulder disability is a result of service or any incident occurring during service. The examiner should provide an opinion as to whether the Veteran’s right or left shoulder disability is at least as likely as not (50 percent probability) proximately due to service-connected left hip, knee or ankle disabilities, to include use of a cane or walker to ambulate. The examiner should address whether it is as likely as not (50 percent probability) that the Veteran’s service-connected left hip, knee or ankle disabilities, to include use of a cane or walker to ambulate, has aggravated his left or right shoulder disabilities beyond natural progression. If aggravation is found, the examiner should identify baseline level of disability prior to such aggravation. The examiner must address the Veteran’s use of a cane or walker as a result of his service connected left leg, hip and foot conditions, and whether relying on his upper body strength to ambulate, has placed stress on his shoulders either causing right or left shoulder disability or aggravating any existing right or left shoulder disability beyond its normal progression. The examiner is reminded that lay reports cannot be rejected solely due to a lack of medical documentation. A reason must be provided if the Veteran’s lay reports are rejected. If there is a medical reason to accept or not accept the Veteran’s contentions, the examiner should provide them. If the absence of medical documentation is relevant, the relevance must be explained because the absence of evidence is not positive evidence of the existence or non-existence of an event. If the examiner is able to gather additional understanding or information regarding the circumstances surrounding any inservice injury or event, the examiner should include that information in his remarks. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and explain why this is so, (e.g., whether an opinion is beyond what any medical practitioner might be able to provide, based on the evidence of record and current medical knowledge). Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. A. Myers 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.