Citation Nr: 21063689 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 16-35 153 DATE: October 15, 2021 REMANDED Service connection for a right shoulder disability, including as secondary to service-connected low back disability, is remanded. Service connection for a neck disability, including as secondary to service-connected low back disability, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from June 1964 to June 1968. These matters are before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision. The Board initially denied these claims in January 2018, but a September 2018 order from the United States Court of Appeals for Veterans Claims (Court) granted a Joint Motion for Partial Remand (JMPR) that vacated those denials. The Board then remanded for additional development in January 2019, October 2019, and July 2020 before denying the claims again in November 2020. The Court granted a second JMPR in June 2021, again vacating those denials. 1. Service connection for a right shoulder disability, including as secondary to service-connected low back disability is remanded. 2. Service connection for a neck disability, including as secondary to service-connected low back disability is remanded. The June 2021 JMPR explicitly found the Board's November 2020 decision improperly relied on July 2019 and September 2020 VA medical opinions because they failed to adequately consider the significance of a competently reported 1966 or 1967 head and back injury or address the question of secondary service connection on an aggravation basis at all. Consequently, a remand is needed for medical clarification. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disabilities remaining on appeal. 2. Schedule the Veteran for an in-person or telehealth (whichever is appropriate) examination by an orthopedist or other appropriate physician to determine the nature and cause of any right shoulder and neck disabilities. Based on a review of the record, examination of the Veteran (INCLUDING A COMPLETE SUBJECTIVE HISTORY AND REPORT DESCRIBING ONSET, COURSE, AND PROGRESSION OF RELEVANT SYMPTOMS), and any tests or studies deemed necessary, the examiner must respond to the following: (a.) Please diagnose all right shoulder and neck disability entities found. All diagnostic findings (or lack thereof) must be reconciled with conflicting evidence in the record. If any previously documented diagnoses are no longer or otherwise not felt to apply, the examiner must explain why, citing to the pertinent diagnostic criteria. (b.) For each right shoulder and neck disability diagnosed, please opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such is related to the Veteran's military service, to include his competent reports of a 1966 or 1967 injury to the back and head. The examiner should specifically consider the Veteran's reports regarding symptom or pathology onset relative to the timing and nature of that injury. (c.) For each right shoulder and neck disability diagnosed, please also opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such is CAUSED BY OR PROXIMATELY DUE TO his service-connected low back disability. The examiner should specifically consider (a) the likelihood that the Veteran's right shoulder or neck disabilities would have developed absent the service-connected low back disability; and (b) whether development of the Veteran's right shoulder or neck disabilities would be a reasonably foreseeable consequence considering his pre-existing low back disability. (d.) For each right shoulder and neck disability diagnosed, please also opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such is AGGRAVATED BY (WORSENED BEYOND ITS NATURAL PROGRESSION TO ANY DEGREE AND FOR ANY AMOUNT OF TIME) his service-connected low back disability. All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Yuan, 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.