Citation Nr: 21062169 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 18-08 930 DATE: October 6, 2021 REMANDED Entitlement to service connection for a heart disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a right upper extremity neurological disability, to include as secondary to a cervical spine disability, is remanded. Entitlement to service connection for a left upper extremity neurological disability, to include as secondary to a cervical spine disability, is remanded. Entitlement to service connection for a right shoulder disability to include as secondary to a cervical spine disability, is remanded. Entitlement to service connection for a left shoulder disability, to include as secondary to a cervical spine disability, is remanded. Entitlement to service connection for a right hand disability, to include as secondary to a cervical spine disability, is remanded. Entitlement to service connection for a left hand disability, to include as secondary to a cervical spine disability, is remanded. Entitlement to service connection for a right hip disability, to include as secondary to his service-connected thoracolumbar spine disability, is remanded. Entitlement to service connection for a left hip disability, to include as secondary to his service-connected thoracolumbar spine disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1975 to June 1979. This case is before the Board of Veterans' Appeals (Board) on appeal from August 2014 and January 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office. In February 2020, the Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. In July 2020, the Board reopened the Veteran's service connection claim for a heart disability and remanded the matter along with other issues on appeal. Since the July 2020 Board decision, the RO granted service connections for chronic constipation, a thoracolumbar spine disability, a bilateral knee disability, and bilateral lower extremity radiculopathy. Now the matters are returned to the Board. 1. Heart disability The Veteran is seeking service connection for a heart disability and contends that it is due to his exposure to toxic chemicals, i.e., tetrachloroethylene (TCE), while serving as a weapons mechanic. Since the July 2020 Board remand, the Veteran underwent a VA examination for heart conditions in February 2021. The February 2021 VA examiner provided a negative etiology opinion and found that the Veteran does not have a diagnosis of a heart disease. The examiner stated that the Veteran had a history of mitral valve prolapse which was resolved, and has recently developed premature atrial complexes. However, a January 2021 echocardiogram showed mild left ventricular hypertrophy, but the examiner failed to discuss the significance of that finding as it relates to the Veteran's current heart condition. In light of the Veteran's competent report of worsening of symptoms and mild left ventricular hypertrophy shown on echocardiogram, the Board finds that an addendum opinion should be obtained to clarify the Veteran's current diagnosis prior to final adjudication of the matter. 2. Cervical spine disability On February 2021 examination for cervical spine conditions, the examiner noted the Veteran's current diagnoses of cervical spine degenerative disc disease and degenerative joint disease status-post discectomy and fusion. Notably, the Veteran reported during the examination that his cervical spine symptoms had its onset after a bad parachute jump in service during which a cord from the airplane wrapped around his neck causing him to have a bad landing after the cord broke. The Veteran stated that he has been experiencing neck pain and degeneration since the in-service injury and had a cervical surgery in 2017. As to the etiology of the Veteran's current cervical spine disability, the February 2021 examiner provided a negative etiology opinion in February and May 2021 by only pointing out that the Veteran's service treatment record does not contain neck complaints. The Board notes that the examiner failed to consider the Veteran's report of an in-service neck injury when rendering the etiology opinion. As the Veteran is found to be competent and credible to report his symptoms of a cervical spine condition and its onset, his report must be sufficiently addressed when determining the etiology of his current disability. Thus, the Board finds that a remand to obtain an addendum opinion is necessary in order to make a fully informed decision. 3. Right and left upper extremity neurological disability The Board notes that the evidence of record shows that the Veteran's loss of feeling and sensation in bilateral upper extremities are due to his cervical spine disability. See e.g., May 2021 Medical Opinion Disability Benefits Questionnaire (DBQ); see also February 2021 Peripheral Nerves Conditions DBQ (the Veteran's diagnosis of bilateral lower extremity radiculopathy was noted). As such, a decision on the remanded issue of the Veteran's entitlement to service connection for a cervical spine condition could significantly impact a decision on the issue of his entitlement to service connection for bilateral upper extremity neurological disability. Thus, the issues are inextricably intertwined, and a remand of the service connection claims for right and left upper extremity neurological disability is also required. 4. Bilateral shoulder and bilateral hand disabilities The evidence also indicates that the Veteran's current bilateral shoulder pain and bilateral hand pain is due to his cervical spine disability, including cervical spine degeneration and radiculopathy. See e.g., February and May 2021 Medical Opinion DBQs. As such, the Board finds that the issues are also inextricably intertwined and the issues of the Veteran's entitlement to service connections for a bilateral shoulder disability and a bilateral hand disability have to be remanded as well. 5. Bilateral hip disability The evidence suggests that the Veteran's bilateral hip disability is due to his lumbar radiculopathy, although the Veteran does have age-related mild hip degeneration. See February 2021 Medical Opinion DBQ. The Board notes that the Veteran is currently service-connected for thoracolumbar spine spinal fusion, spinal stenosis, and spondylosis. Service connection may also be granted for a disability that is proximately due to or the result of an established service-connected disability. 38 C.F.R. § 3.310 (2020). This includes disability made chronically worse by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Therefore, the Board finds that a medical opinion in regard to the causal relationship between the Veteran's current bilateral hip disability and his service-connected thoracolumbar disability should be obtained in order for the Board to make a fully informed decision on the matter. Accordingly, the matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) must obtain an addendum opinion from the February 2021 VA examiner regarding the Veteran's service connection claim for a heart disability. If the February 2021 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. The examiner should review the Veteran's claims file and a copy of this REMAND order before rendering the requested addendum opinion. The examiner is asked to clarify the Veteran's current diagnosis related to his heart. In particular, the examiner is asked to discuss the Veteran's worsening of chest pain and heart fluttering reported during the February 2021 examination and mild left ventricular hypertrophy shown on the January 2021 echocardiogram as it relates to his current heart condition. The examiner is advised that the Veteran is competent to report his symptoms and history and such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. Then, the examiner must opine whether the Veteran's current heart disability is at least as likely as not (50 percent or greater probability) related to his service, to include his exposure to TCE, or had its onset in service. The examiner must provide a complete written rationale for any opinion offered. 2. The AOJ must obtain a medical opinion from an appropriate medical examiner regarding the Veteran's service connection claim for a bilateral hip disability. The examiner should review the Veteran's claims file and a copy of this REMAND order before rendering the requested medical opinion. The examiner must opine whether the Veteran's current bilateral hip disability is at least as likely as not (50 percent or greater probability) secondary to his service-connected thoracolumbar spine spinal fusion, spinal stenosis, and spondylosis. The examiner must provide a complete written rationale for any opinion offered. 3. After completing the above actions and any other necessary development, the issues on appeal, including the inextricably intertwined issues, must be readjudicated. If the claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Kim, 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.