Citation Nr: 21005131 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 14-25 122A DATE: January 29, 2021 REMANDED Entitlement to service connection for a right arm and shoulder condition is remanded. REASONS FOR REMAND The Veteran had active military service from May 1983 to July 2008. This matter comes before the Board of Veterans Appeals (Board) on appeal from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. The Board previously considered this appeal in May 2018 and in June 2020 and remanded this issue for further development including scheduling VA examinations. The case returned to the Board for further appellate review. 1. Entitlement to service connection for a right arm and shoulder condition is remanded. The Veteran contends that he is entitled to service connection for his right arm and shoulder condition, to include as secondary to the service-connected cervical spine condition. The Veteran was afforded a VA examination for the right arm and shoulder disability in September 2016. In its May 2018 decision, the Board remanded the claim for another examination as the September 2016 VA examination did not discuss direct service connection and the Veteran had further raised another secondary argument that his right arm and shoulder disabilities were caused or aggravated by the diagnosed cervical radiculopathy. A July 2019 VA examination for the Shoulder and Arm confirmed a diagnosis of rotator cuff tendonitis and rotator cuff tear. The examiner concluded the condition was less likely than not (less than 50 percent probability) related to service. The July 2019 VA examiner reasoned that a “2016 Medical exam and workup describes “Right shoulder pain X 1 year”. I could not locate evidence of a chronic right shoulder condition on review of the STRs. It is therefore less likely that the current chronic right shoulder condition of rotator cuff tendinosis incurred after service.” Regarding the right arm and shoulder condition been related to the cervical spine condition, the examiner stated that a cervical spine condition would not have any impact on a rotator cuff, as a rotator cuff injury is typically due to overuse or strain injury unrelated to the degenerative pathology in the cervical spine. In June 2020, the Board again remanded the issue for another medical opinion to reconcile the medical evidence that shows prior diagnoses of radiculopathy or tendinosis, the presence of cervical radiculopathy and to provide an opinion as to the nature and etiology of the right shoulder and arm condition. In the September 2020 medical opinion report, the VA examiner stated that a after thorough review of the MRI, EMG and DBQs, the Veteran has the following right shoulder conditions: radiculitis of the circumflex nerve, rotator cuff tendonitis and rotator cuff tear that were demonstrated on the MRI of 2016 of the right shoulder and added that the Veteran does not have cervical radiculopathy as noted by the two EMGs. The VA examiner opined that the right arm and shoulder condition is less likely than not proximately due or the result of the Veteran’s service-connected condition. The rationale provided is that the Veteran’s rotator cuff tendonitis and rotator cuff tear are due to overuse and repetitive movements and not due to secondary DDD of the cervical spine. The VA examiner further added that the Veteran’s radiculitis is due to the rotator cuff injury causing irritation of the circumflex nerve. Regarding aggravation, the VA examiner opined that the Veteran’s right arm and shoulder condition is not at least as likely as not aggravated beyond its natural progression by the service-connected cervical spine condition. The rationale provided is that the veteran's DDD of the spine is limited to the spine and does not cause or aggravate the other conditions. Although the Board sincerely regrets the additional delay, another remand is required to ensure the Veteran is afforded every possible consideration and the Board's previous remand directives are complied with. While the Board finds that the record contains adequate VA opinions on secondary service connection that also address aggravation, there is not an adequate VA opinion of record that addresses direct service connection. The July 2019 VA examiner submitted a negative direct nexus opinion basically due to lack of evidence of a chronic condition. The September 2019 VA examiner stated that the Veteran’s rotator cuff tendonitis and rotator cuff tear are due to overuse and repetitive movements. However, none of the VA examiners have addressed the Veteran’s MOS or the Veteran’s statements. Furthermore, in March 2017, the Veteran testified that his career in the military consisted of very physically demanding tasks that he believes lead to the development of his right arm and shoulder disabilities. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Therefore, remand is required for an adequate VA opinion that addresses direct service connection. The matters are REMANDED for the following action: 1. Obtain an opinion from a qualified clinician to determine the nature and etiology of the Veteran's right arm and shoulder conditions. The evidentiary record, including a copy of this remand, must be made available to and be reviewed by the clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary, the reviewing clinician is asked to respond to the following inquiries: (a.) Is it at least as likely as not that the Veteran's right arm shoulder condition was incurred in, or is otherwise related to service? The examiner must discuss the 2020 examiner’s conclusion that the rotator cuff tendonitis and tear were due to overuse and repetitive movement and also discuss the Veteran’s description of his physically demanding tasks in the military. A complete rationale for all opinions is required. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Romero-Sanchez, 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.