Citation Nr: 21064256 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 19-27 304 DATE: October 19, 2021 ORDER Entitlement to service connection for a neck disability is granted. Entitlement to service connection for a right shoulder disability is granted. Entitlement to service connection for a left shoulder disability is granted. Entitlement to service connection for a low back disability is granted. Entitlement to service connection for a right knee disability is granted. Entitlement to service connection for a left knee disability is granted. REMANDED Entitlement to service connection for neuropathy of the right upper extremity (claimed as carpal tunnel syndrome (CTS)) is remanded. Entitlement to service connection for neuropathy of the left upper extremity (claimed as CTS) is remanded. Entitlement to service connection for neuropathy of the right lower extremity neuropathy is remanded. Entitlement to service connection for neuropathy of the left lower extremity is remanded. FINDINGS OF FACT 1. The probative evidence of record shows that the Veteran's neck disability was incurred in service or related to incidents therein. 2. The probative evidence of record shows that the Veteran's right shoulder disability was incurred in service or related to incidents therein. 3. The probative evidence of record shows that the Veteran's left shoulder disability was incurred in service or related to incidents therein. 4. The probative evidence of record shows that the Veteran's lumbar spine disability was incurred in service or related to incidents therein. 5. The probative evidence of record shows that the Veteran's right knee disability was incurred in service or related to incidents therein. 6. The probative evidence of record shows that the Veteran's left knee disability was incurred in service or related to incidents therein. CONCLUSIONS OF LAW 1. The criteria for service connection for a neck disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for a right shoulder disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria for service connection for a left shoulder disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria for service connection for a lumbosacral disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for service connection for a right knee disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 6. The criteria for service connection for a left knee disorder are met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1951 to September 1953. The issues come before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board has expanded the Veteran's claims for service connection for neuropathy of the right upper and left extremities as characterized above. Under Clemons v. Shinseki, 23 Vet. App. 1 (2009), the scope of a disability claim includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. The Veteran and his wife, A. H., testified at a videoconference Board hearing in January 2020 before the undersigned Veterans Law Judge (VLJ). A copy of the transcript is of record. The issues were previously before the Board in March 2020 and October 2020 and were remanded. The most previous remand of October 2020 mandated that the RO provide the Veteran with supplemental medical opinions addressing the etiology of his disorders. A medical opinion was provided in March 2021, with an addendum in August 2021. As is explained below, the Board finds the opinion and accompanying addendum incomplete, and therefore, there has not been substantial compliance. Stegall v. West, 11 Vet. App. 268, 271 (1998). Notwithstanding, as the Board is herein granting service connection for the arthritic joint disabilities, a remand for an adequate medical opinion addressing the etiology of these issues is not warranted. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110 (2012); 38 C.F.R. § 3.303. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity for certain diseases. 38 C.F.R. §§ 3.303 (a), (b), 3.309(a); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303; Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a "competent" source. The Board must then determine if the evidence is credible or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence considering the entirety of the record. The standard of proof to be applied in decisions on claims for veterans' benefits is outlined in 38 U.S.C. § 5107 (2012). A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to service connection for a cervical (neck) disability is granted. 2. Entitlement to service connection for a right shoulder disability is granted. 3. Entitlement to service connection for a left shoulder disability is granted. 4. Entitlement to service connection for a low back disability is granted. 5. Entitlement to service connection for a right knee disability is granted. 6. Entitlement to service connection for a left knee disability is granted. The Veteran carries diagnoses of arthritis in the spine (cervical and lumbar), bilateral shoulder, and knees. The Veteran contends that his disabilities are related to service. He credibly and competently testified that while in service, he worked in artillery and lifted 155-millimeter cannons. From said heavy lifting, he hurt his back and neck and was even hospitalized in Germany and Puerto Rico for injuries sustained. Regarding his knees and shoulders, his disabilities are from the wear and tear from the constant lifting, for which he was seen by the in-service medics and was given ACE bandages, ice, and pills. Furthermore, he testified that all his disabilities continued after service. However, he had good insurance coverage from his employer, which took care of his disabilities, until his retirement in 2004, when he sought continued treatment with the VA. He and his wife additionally testified that his post-service employment was in a laboratory in a petroleum refinery, which was not a physically demanding job. As noted previously, the record indicates that in September 2018, the Personnel Information Exchange System (PIES) reported that the Veteran's service treatment records (STRs) were destroyed in a fire at the National Personnel Records Center (NPRC) in1973. Thus, in cases where service treatment records are lost due to no fault of the Veteran, the Board has a heightened obligation to explain its findings and conclusions and to consider the benefit-of-the-doubt rule carefully. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Veteran was afforded a VA medical opinion in March 2021 with an addendum in August 2021. The examiner noted the diagnoses of strains in the lumbar, cervical, bilateral knee and left shoulder, and right shoulder joint replacement. He proffered a negative nexus for each disability. He, however, did not address nor opined on the Veteran's arthritics disabilities nor the credible and competent lay statements of continuity of symptomology. Thus, the examination is inadequate. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The Veteran's post-service treatment records contain a VA clinical entry of November 2020 noting the following: "the Veteran ha[d] multiple joint pain that is commonly seen in an individual with a history of repetitive lifting of heavy weights such as shells used during artillery." The clinician then concluded that the "joint disorder[s] are related to heavy lifting he endured during service..." The Board finds that the VA clinician's November 2020 finding provides the nexus element for the Veteran's lumbar, cervical, bilateral knee, and bilateral shoulder disabilities. Further, there is no adequate opinion contrary to the findings. Accordingly, as the preponderance of the probative evidence of record weighs in favor that the Veteran's above-said disabilities started in service and continued. Thus, the Board finds that service connection is granted for the said claims. 38 U.S.C. § 5107 (b) (2012). REASONS FOR REMAND 1. Entitlement to service connection for neuropathy of the right upper extremity is remanded. 2. Entitlement to service connection for neuropathy of the left upper extremity is remanded. 3. Entitlement to service connection for neuropathy of the right lower extremity neuropathy is remanded. 4. Entitlement to service connection for neuropathy of the left lower extremity is remanded. The Veteran contends that his neuropathy was incurred in service. Alternatively, during his Board hearing, he testified that radiculopathy of the bilateral upper and lower extremities might be secondarily related to his back and neck disabilities. The Veteran was afforded a VA medical opinion in March 2021 and an addendum in August 2021. The examiner proffered a negative nexus to service and explained that the "Veteran state[d] that all of the claimed conditions onset due to injury sustained while lifting a cannon during service. However, there is no evidence to support any injury while in service. The separation exam from 1953 was normal. Further, it has been 67 years since the Veteran was in service, with no chronicity of symptoms during this time to support a nexus. All of these conditions are age-related changes, and while the Veteran's testimony is credible, the plethora of medical evidence for these conditions being age-related is much more likely than one acute reported injury 67 years ago." Again, the Board finds the opinion wanting and therefore incomplete. While the examiner noted the Veteran's credible testimony, she primarily relied on the absence of in-service evidence and neglected the lay argument of continuity of symptomology. Barr, 21 Vet. App. 303, 308 (2007). Additionally, as the Veteran's cervical, lumbar, shoulder, and knee disabilities had not been service connected at the time, he proffered not an opinion on secondary service connection for his diagnosed radiculopathy. As there is no adequate medical opinion of record addressing direct or secondary service connection, the Board finds that a supplemental opinion is warranted. Accordingly, the matters are REMANDED for the following action: 1. Provide the Veteran's claims file to a qualified clinician, other than G. H., NP, so that a supplemental opinion may be provided for his radiculopathy of the bilateral upper and lower extremities. A physical or telehealth examination of the Veteran is only required if deemed necessary by the clinician. The entire claims file and a copy of this remand must be made available to the clinician to review. Radiculopathy of the Bilateral Upper Extremity/CTS: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's radiculopathy of the right and left upper extremities had their onset in and/or are otherwise etiologically related to his period of active service. b. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's radiculopathy of the right and left upper extremities is proximately due to or the result of his service-connected cervical and/or bilateral shoulder disability. c. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's radiculopathy of the right and left upper extremities has been aggravated beyond its natural progression by his service-connected cervical and/or bilateral shoulder disability. The clinician is reminded that for a secondary service connection claim, a VA medical opinion should not combine causation and aggravation; separate findings and rationales should be provided for each one. Atencio v. O'Rourke, 30 Vet. App. 74, 90 (2018). The clinician must provide a complete rationale for his or her opinion(s) in the examination report that reflects consideration of all pertinent evidence of record, including the Veteran's lay statements. If any of the above-requested opinions cannot be made without resort to speculation, the clinician must state this and provide a rationale for such a conclusion. Radiculopathy of the Bilateral Lower Extremity a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's radiculopathy of the right and left lower extremities had their onset in and/or are otherwise etiologically related to his period of active service. b. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's radiculopathy of the right and left extremities is proximately due to or the result of his service-connected lumbar and/or bilateral knee disability. c. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's radiculopathy of the right and left lower extremities has been aggravated beyond its natural progression by his service-connected lumbar and/or bilateral knee disability. The examiner is reminded that for the examination to be adequate, the medical opinion must provide explanations for both the aggravation and causation prongs of a secondary service connection claim. Atencio, 30 Vet. App. 74 (2018). The clinician must provide a complete rationale for his or her opinion(s) in the examination report that reflects consideration of all pertinent evidence of record, including the Veteran's lay statements. If any of the above-requested opinions cannot be made without resorting to speculation, the clinician must state this and provide a rationale for such a conclusion. 2. Then, readjudicate the claims. If the decision is unfavorable to the Veteran, issue a Supplemental Statement of the Case (SSOC) and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Stevens, 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.