Citation Nr: 21004773 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 16-19 868 DATE: January 28, 2021 ORDER A rating in excess of 10 percent for degenerative joint disease of the left knee is denied. A rating in excess of 10 percent for degenerative joint disease of the right knee is denied. The separate rating for left knee instability, evaluated as 10 percent disabling as of February 10, 2020, is proper; the appeal is denied. The separate rating for right knee instability, evaluated as 10 percent disabling as of February 10, 2020, is proper; the appeal is denied. REMANDED Entitlement to service connection for a back disorder, to include as secondary to service-connected right shoulder degenerative arthritis, is remanded. Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected right shoulder degenerative arthritis, is remanded. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s degenerative joint disease of the left knee is manifested by objective evidence of arthritis with painful motion resulting in flexion limited to no more than 75 degrees and full extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination or as a result of repetitive motion and/or flare-ups, without ankylosis, dislocation or removal of semilunar cartilage, lateral instability or recurrent subluxation prior to February 10, 2020, impairment of the tibia or fibula, or genu recurvatum. 2. For the entire appeal period, the Veteran’s degenerative joint disease of the right knee is manifested by objective evidence of arthritis with painful motion resulting in flexion limited to no more than 80 degrees and full extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination or as a result of repetitive motion and/or flare-ups, without ankylosis, dislocation or removal of semilunar cartilage, lateral instability or recurrent subluxation prior to February 10, 2020, impairment of the tibia or fibula, or genu recurvatum. 3. As of February 10, 2020, the Veteran’s degenerative joint disease of the left knee results in no more than slight instability. 4. As of February 10, 2020, the Veteran’s degenerative joint disease of the right knee results in no more than slight instability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for degenerative joint disease of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5010-5260. 2. The criteria for a rating in excess of 10 percent for degenerative joint disease of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5010-5260. 3. The separate rating for left knee instability, evaluated as 10 percent disabling as of February 10, 2020, is proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5010-5257. 4. The separate rating for right knee instability, evaluated as 10 percent disabling as of February 10, 2020, is proper. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5010-5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1985 to January 1988, and January 2003 to May 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in May 2014 by a Department of Veterans Affairs (VA) Regional Office (RO). In January 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In January 2020, the Board remanded the issues on appeal, as well as a claim for service connection for a right shoulder disorder, for additional development. While on remand, a September 2020 rating decision awarded service connection for right shoulder degenerative arthritis. As such is a full grant of the benefit sought with respect to such issue, it is no longer before the Board. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Such rating decision also awarded separate 10 percent ratings for left and right knee instability, effective February 10, 2020. As the propriety of the assigned ratings and effective dates for such separate ratings are part and parcel of the Veteran’s claims for increased ratings for his bilateral knee disabilities, the Board has assumed jurisdiction over such matters. VAOPGCPREC 23-97 (July 1, 1997); VAOPGCPREC 9-98 (Aug. 14, 1998) (separate ratings may be assigned for arthritis with painful motion and instability of the knee). The Board observes that, subsequent to the issuance of the September 2020 supplemental statement of the case, additional treatment records and unrelated VA examinations were associated with the record; however, as such are irrelevant to the instant matters or include duplicative findings previously considered by the Agency of Original Jurisdiction (AOJ), there is no prejudice to the Veteran in the Board proceeding with a decision at this time. 38 C.F.R. § 20.1305(c). Finally, the Board notes that the Veteran was previously represented by an attorney in his appeal. However, while the case was pending at the AOJ, VA received communication indicating that he revoked her representation in September 2020. Thus, the Veteran is not currently represented in the instant appeal. 1. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the left knee. 2. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the right knee. 3. Propriety of the assignment of the separate rating for left knee instability, evaluated as 10 percent disabling as of February 10, 2020. 4. Propriety of the assignment of the separate rating for right knee instability, evaluated as 10 percent disabling as of February 10, 2020. Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. As relevant to the evaluation of the Veteran’s right hip and right knee disabilities, disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the Court held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). The appeal period before the Board stems from the Veteran’s April 8, 2013, claims for increased ratings for his service-connected left and right knee disabilities, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For the entire appeal period, such disabilities have been rated as 10 percent disabling pursuant to DC 5010-5260. Under DC 5010, traumatic arthritis is evaluated as degenerative arthritis. Degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003. DC 5003 provides that when limitation of motion due to arthritis is noncompensable under the appropriate diagnostic code, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. In the absence of limitation of motion, DC 5003 provides for a 10 percent rating with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. A 20 percent rating under DC 5003 requires involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. For the purpose of rating disability from arthritis, the knee is considered a major joint. See 38 C.F.R. § 4.45. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, DC 5260 and 5261. DC 5260 provides for a zero percent rating where flexion of the leg is only limited to 60 degrees. For a 10 percent rating, flexion must be limited to 45 degrees. For a 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. DC 5261 provides for a zero percent rating where extension of the leg is limited to five degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees. A 30 percent rating may be assigned where the evidence shows extension limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. Finally, where extension is limited to 45 degrees a 50 percent rating may be assigned. VA’s General Counsel has stated that separate ratings under DC 5260 (limitation of flexion of the leg) and DC 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 (2004). Furthermore, as of February 10, 2020, the Veteran is in receipt of separate 10 percent ratings for instability of the left and right knees pursuant to DC 5257. Such DC provides for assignment of a 10 percent rating when there is slight recurrent subluxation or lateral instability, a 20 percent rating when there is moderate recurrent subluxation or lateral instability, and a 30 percent rating for severe recurrent subluxation or lateral instability. Turning to the evidence of record, the Veteran was afforded a VA examination in April 2014. At such time, he reported flare-ups described as swelling that made him limp. Examination showed right knee flexion to 135 degrees with pain beginning at 130 degrees and full extension with pain, and normal left knee flexion to 140 degrees with pain beginning at 135 degrees and full extension with pain. The Veteran had additional limitation in range of motion with right knee flexion to 130 degrees and left knee flexion to 135 degrees on repetitive-use testing due to functional loss and/or functional impairment of less movement than normal and pain on movement. He did not have tenderness or pain to palpation on the joint line or soft tissues and his muscle strength was normal bilaterally. His joint stability tests were normal and there was no evidence or history of recurrent patellar subluxation or dislocation, impairment of the tibia and/or fibula, meniscal conditions, or surgery. The Veteran did not use any assistive devices. The examiner noted that his bilateral knee disabilities impacted his ability to work as his inability to walk or stand for prolonged periods may cause pain. During his January 2019 Board hearing, the Veteran testified that he experienced pain, swelling, cramping, and tightness in his knees; had difficulty with prolonged walking and standing, working out when trying to lift an object, and trouble bending his knees; and wore knee braces. He also indicated that he had experienced a decrease in the range of motion of his knees, and his activities had become more limited. Thus, the Board remanded the case in order to afford the Veteran a new VA examination so as to address the current nature and severity of his bilateral knee disabilities. On February 10, 2020, the Veteran underwent another VA examination, at which time he reported swelling and buckling of his knees, pain, and an inability to walk long distances. He indicated that he had flare-ups that occurred every day, and experienced functional loss or functional impairment when walking long distances, using stairs, and squatting. Range of motion testing revealed right knee flexion to 85 degrees and full extension, and left knee flexion to 80 degrees and full extension. There was pain on flexion bilaterally with active and passive range of motion and on weight-bearing and nonweight-bearing, which resulted in/caused functional loss. His range of motion contributed to functional loss, to include sitting and standing for only 10 minutes at a time, walking only 20 feet at a time, no lifting, and resting after going up and down one step at a time. There was localized tenderness or pain on palpation of the joint or associated soft tissue bilaterally, but no crepitus bilaterally. There was additional loss of function/range of motion caused by pain on repetitive-use testing, described as right knee flexion to 80 degrees and left knee flexion to 75 degrees with no loss of extension. The examiner indicated that pain significantly limited functional ability with flare-ups and repeated use over time, resulting in right knee flexion to 80 degrees and left knee flexion to 75 degrees with no loss of extension. The Veteran’s muscle strength tests were normal. No ankylosis was present. There was a history of moderate lateral instability bilaterally. Anterior instability testing was normal bilaterally; posterior instability testing was normal in the right knee, but 1+ (0-5 millimeters) in the left knee; and medial-lateral instability was 1+ (0-5 millimeters) bilaterally. There was no evidence or history of recurrent patellar subluxation. The examiner noted that the Veteran had bilateral shin splits that did not affect range of motion of the knee or ankle, and did not have any current symptoms as such disorder had been quiescent since military service. There was no evidence of meniscal conditions or surgery. The Veteran did not use any assistive devices. The examiner further noted that the Veteran’s bilateral knee disabilities impacted his ability to work as he could only sit and stand for 10 minutes at a time, walk 20 feet at a time; could not do any lifting; and had to rest after going up and down one step at a time. In this case, the Board finds the foregoing VA examinations are adequate for rating purposes. In this regard, such reflect that the Veteran was asked about pain, flare-ups, and functional limitations, and relevant testing was performed. Here, if he endorsed experiencing flare-ups, the examiners elicited information regarding frequency, duration, characteristics, severity, and/or functional loss related to such flare-ups. Although the April 2014 VA examiner did not provide information regarding the additional loss of range of motion that may be present during the Veteran’s reported flare-ups, the February 2020 VA examiner did. See Sharp, supra. Furthermore, while the prior VA examination did not fully address all relevant elements articulated in Correia, supra, the February 2020 VA examination fully complied with the Court’s holding in such case. VA treatment records dated throughout the appeal period reflecting ongoing complaints of bilateral knee pain, which was worse on the right side. In October 2013, the Veteran reported experiencing swelling of the right knee and, in November 2015, he complained of aching in his bilateral knees, but had normal range of motion. In November 2016 and January 2017, examination revealed normal range of motion bilaterally and no swelling; however, at the latter appointment, it was noted that the Veteran had tenderness to palpation of the knees and reported occasional swelling. In August 2017, examination revealed normal range of motion bilaterally and no swelling. In March 2018, the Veteran reported occasional knee swelling with chronic pain made worse by walking one block. However, examination revealed normal range of motion bilaterally and no swelling. In June 2020, the Veteran denied falls, weakness, and swelling. Limitation of Motion On review of the evidence, the Board finds that the Veteran’s bilateral knee disabilities do not warrant ratings in excess of 10 percent based on limitation of motion under DC 5260 or DC 5261. Specifically, the evidence demonstrates that his left and right knee extension has remained full; and his left knee flexion is limited to, at most, 75 degrees, and right knee flexion is limited to, at most 80 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups. Further, the Veteran is in receipt of the minimal compensable ratings under the provisions of DC 5003 for painful limitation of motion due to arthritis that is not otherwise compensable. Instability The Veteran been assigned separate 10 percent ratings under DC 5257 for slight lateral instability as of February 10, 2020. However, as the evidence fails to demonstrate the presence of instability prior thereto such that an increase in the Veteran’s bilateral knee disabilities was factually ascertainable, the Board finds that such separate ratings may not be assigned prior to February 10, 2020. In this regard, the Board notes that DC 5257 does not require objective medical evidence of lateral instability for a rating to be assigned. English v. Wilkie, 30 Vet. App. 347 (2018). However, while the Veteran is competent to report wearing knee braces, and reported a history of moderate lateral instability bilaterally at the February 2020 VA examination, he is not competent as a lay person to diagnose lateral instability or recurrent subluxation as such requires the administration and interpretation of specialized testing of the ligaments and patella, respectively. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Rather, the April 2014 VA examiner, who has the training to administer and interpret ligament and patellar testing, found that there was no laxity or subluxation in the bilateral knees. Furthermore, such determination is supported by the Veteran’s VA treatment records, which are negative for any indication of lateral instability. Thus, the Board affords greater probative weight to medical evidence of record, to specifically include the April 2014 VA examiner who found no instability or subluxation in the bilateral knees, than the Veteran’s generalized statements regarding the presence of such impairment. See, e.g., Waters v. Shinseki, 601 F.3d 1274, 1278 (2010). Thus, prior to February 10, 2020, a separate rating for instability of the right or left knee under DC 5257 is not warranted. Furthermore as of such date, the Board finds that a rating in excess of 10 percent for such disabilities is not warranted. In this regard, the February 2020 VA examination revealed that anterior instability testing was normal bilaterally and posterior instability testing was normal in the right knee, and posterior instability testing in the left knee and medial-lateral instability bilaterally was measured as no worse that 1+ (0-5 millimeters). Furthermore, the Veteran’s VA treatment records are negative for any indication of instability and, in June 2020, reflect that he denied falls and weakness. Moreover, he has been able to continue to engage in various physical activities during the appeal, including working. Therefore, based on the results from objective testing and related lack of functional impairment, the Board finds that the Veteran’s instability of the bilateral knees is no more than slight. Consequently, ratings in excess of 10 percent are not warranted. Other Considerations The Board has also considered whether the Veteran is entitled to any additional separate ratings for his right and left knee disabilities. However, as the evidence does not show ankylosis, dislocation or removal of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum, higher or separate ratings under DCs 5256, 5258, 5259, 5262, and 5263, respectively, are not warranted. In reaching the foregoing conclusions, the Board acknowledges the Veteran’s belief that his bilateral knee disabilities are more severe than as reflected by the current disability ratings. However, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert, supra. Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of his bilateral knee disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of such disabilities. The Board has also considered whether additional staged ratings under Hart, supra, are appropriate for the Veteran’s service-connected bilateral knee disabilities; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for such disabilities are not warranted. Further, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Thus, the Board finds that increased ratings for the Veteran’s bilateral knee disabilities are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against such claims, the benefit of the doubt doctrine is not applicable in such regard and the Veteran’s increased rating claims must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 5. Entitlement to service connection for a back disorder, to include as secondary to service-connected right shoulder degenerative arthritis. Pursuant to the January 2020 Board remand, the Veteran underwent a VA examination in February 2020, at which time the examiner noted a diagnosis of degenerative arthritis of the lumbar spine. However, as relevant, in an August 2020 VA medical opinion, an examiner found that such disorder was less likely than not proximately due to or the result of the Veteran’s service-connected right shoulder disability. As rationale for the opinion, he reported that no lumbar spine disorder was noted on VA examination in April 2014, and the lumbar spine had no relationship with the shoulder for causal purposes. However, the non-documentation of a diagnosis related to the Veteran’s back as described by the August 2020 examiner is not consistent with the record. To the contrary, as indicated previously, the record includes a February 2020 VA examination report that reflects a diagnosis of degenerative arthritis of the spine. Thus, such opinion appears to be based on an incomplete factual history. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinions based on inaccurate factual premise are not probative). Further, the August 2020 VA examiner did not address whether the Veteran’s back disorder is aggravated by his service-connected right shoulder disability. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that findings of “not due to,” “not caused by,” and “not related to” a service-connected disability are insufficient to address the question of aggravation under § 3.310(b)). Consequently, the Board finds that a remand is necessary to obtain an addendum opinion addressing such matter. 4. Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected right shoulder degenerative arthritis. In the January 2020 Remand, the Board directed that the Veteran be afforded a VA examination so as to determine the nature and etiology of his cervical spine disorder. As relevant, the Board requested that the examiner offer an opinion as to whether such disorder had its onset in, or is otherwise related to, the Veteran’s military service, to include his documented complaint of neck stiffness and/or reported right shoulder injury after lifting weights above his head while deployed from July 2003 to March 2004 in Afghanistan. In this regard, the examiner was advised that the sole basis of a negative nexus opinion may not be the lack of complaints, treatment, or diagnosis referable to a cervical spine disorder in the service treatment records. In February 2020, following an examination, a VA examiner opined that the Veteran’s cervical spine disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the only rationale provided was that there was no documentation in the Veteran’s service treatment records of any diagnosis or treatment related to the cervical spine other than the August 1985 STR reflecting his complaint of neck stiffness. Thus, an addendum opinion with an adequate rationale is needed to determine whether the Veteran’s cervical spine disorder is related to his military service. The matters are REMANDED for the following action: 1. Return the record, to include a copy of this Remand, to the VA examiner who rendered the August 2020 VA medical opinion in regard to the Veteran’s back disorder for an addendum opinion. If he is not available, the record should be provided to an appropriate examiner so as to render the requested opinion. Following a review of the record, the examiner is requested to offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s currently diagnosed degenerative arthritis of the lumbar spine is caused or aggravated by his service-connected right shoulder degenerative arthritis. In offering such opinion, the examiner should consider the Veteran’s report that, following his in-service right shoulder injury due to lifting weights above his head, he began to experience back pain, and his treatment providers stated that they believed his back pain was related to his right shoulder. If aggravation is found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. A rationale should be provided for any opinion offered. 2. Return the record, to include a copy of this Remand, to the VA examiner who completed the February 2020 neck examination for an addendum opinion. If he is not available, the record should be provided to an appropriate examiner so as to render the requested opinion. Following a review of the record, the examiner is requested to offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s currently diagnosed cervical spine spondylosis had its onset in, or is otherwise related to, his military service, to include his documented complaint of neck stiffness in August 1985, and/or reported right shoulder injury after lifting weights above his head while deployed from July 2003 to March 2004 in Afghanistan. The examiner is advised that the sole basis of a negative nexus opinion may not be the lack of complaints, treatment, or diagnosis referable to a cervical spine disorder in the Veteran’s service treatment records. A rationale should be provided for any opinion offered. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, 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.