Citation Nr: 21063485 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 14-38 286A DATE: October 14, 2021 REMANDED Entitlement to service connection for chronic left shoulder disability is remanded. Entitlement to service connection for left wrist carpal tunnel is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1974 to January 1994. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claims for service connection for chronic left shoulder disability and left wrist carpal tunnel were previously remanded in September 2020 for further development. For the reasons discussed below, remand is again warranted. 1. Entitlement to service connection for chronic left shoulder disability is remanded. The September 2018 Board decision remanded the Veteran's claim for entitlement to service connection for chronic left shoulder disability for a new VA examination. Remand directives instructed that the Veteran be scheduled for an examination by an appropriate clinician to determine the nature and etiology of any left shoulder disability, to include left shoulder strain and acromioclavicular joint arthritis. Directives further noted that if an examination could not be scheduled at a location to which the Veteran could safely travel, or if health considerations make the scheduling of an in-person examination not possible, the AOJ should consider whether other virtual options, to include telehealth interviews or examinations are possible. Upon examination, the examiner was instructed to opine whether any left shoulder disability at least as likely as not began during service, manifested within one year after discharge from service, or was noted during service with continuity of the same symptomatology since service. The examiner was specifically instructed to address the Veteran's competent reports of shoulder pain in May 1994 VA examination report and May 1995 private treatment report. The examiner was also instructed to opine whether the Veteran's left shoulder disability was proximately due to service-connected disability or aggravated beyond its natural progression by service-connected disability to include cervical spine disability or falls from a service-connected lumbar spine disability with associated bilateral lower extremity radiculopathy. An addendum opinion was obtained in March 2021. The examiner opined that it is less likely than not that the Veteran has a left shoulder condition which started in service, related to service in any way or caused by other service-connected conditions such as cervical radiculopathy or falls due to lumbar radiculopathy. The examiner further opined that the Veteran's complaint of pain in left shoulder is related to cervical radiculopathy and not an intrinsic left shoulder musculoskeletal problem. Notably, the examiner also noted that the Veteran has mild degenerative changes of the AC joint. At the outset, the Board notes that the Veteran was not scheduled for a VA examination as requested by the remand directives, instead an addendum opinion was obtained. It is unclear from the record that any attempt was made to consider whether other virtual options, to include telehealth interviews or examinations are possible. With respect to the opinion rendered, while the examiner offered a direct service connection opinion, and opined that the Veteran's left shoulder disability was not caused by the Veteran's service-connected disabilities; the examiner did not opine whether the Veteran's disability, to include degenerative changes of the AC joint, was aggravated beyond its natural progression by the Veteran's service-connected disabilities. Additionally, the examiner did not address the Veteran's competent lay statements regarding shoulder pain during his May 1994 and May 1995 examinations. A remand by the Board imposes a concomitant duty to ensure compliance with the terms of the remand. Where the remand orders are not complied with, the Board itself errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). As the September 2020 remand directive were not substantially complied with, remand is warranted for a new VA examination. 2. Entitlement to service connection for left wrist carpal tunnel is remanded. The Veteran's claim for service connection for left wrist carpal tunnel to include as secondary to the Veteran's service-connected disabilities remains inextricably intertwined with the claim for entitlement to service connection for a left shoulder disability. A such a remand of the claim is required. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Schedule the Veteran for an in-person examination by an appropriate clinician, different than any previous opinion providers, to determine the nature and etiology of any left shoulder disability, to include left shoulder strain and acromioclavicular joint arthritis. The claims folder must be made available to and reviewed by the examiner. The examiner should take a history from the Veteran as to the progression of his disability. Upon review of the file, and interview and examination of the Veteran, the examiner is asked to respond to each of the following: (a) Opine as to whether any left shoulder disability at least as likely as not (1) began during active service, to include as related to an in-service automobile accident, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. In providing a response to this question, the examiner should address the Veteran's competent reports of shoulder pain in the May 1994 VA examination report and May 1995 private treatment records. (b) If the examiner finds that a left shoulder disability was not incurred in or otherwise related to service, the examiner must opine whether any left shoulder disability is at least as likely as not (1) proximately due to service-connected disability, to include a cervical spine disability, or (2) aggravated beyond its natural progression by service-connected disability, to include a cervical spine disability, or falls from a service-connected lumbar spine disability with associated bilateral lower extremity radiculopathy. (Continued on the next page) All opinions should be supported by and medical explanation or rationale. 3. After the above development, and any additionally indicated development has been completed, readjudicate the issues on appeal. If the benefits sought are denied send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Wimbish, 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.