Citation Nr: 21064269 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-17 125A DATE: October 19, 2021 REMANDED Entitlement to service connection for a bilateral shoulder disability is remanded. Entitlement to service connection for left shoulder disability is remanded. Entitlement to service connection for right foot disability is remanded. Entitlement to service connection for left foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1972 to November 1973. These matters come to the Board of Veterans' Appeals (Board) from an April 2013 rating decision. The Veteran filed a notice of disagreement (NOD) in April 2014, which resulted in a March 2017 statement of the case (SOC). Subsequently, the Veteran filed a substantive appeal in April 2017. The claims came before the Board in January 2019 and September 2019 and they were remanded for further development. The Veteran was not provided VA examinations regarding his claimed bilateral shoulder and foot disabilities. The Veteran's primary care provider wrote a letter in September 2015 indicating that the Veteran has multiple musculoskeletal problems that are secondary to his now service-connected back disability. The Board cannot rely on this opinion because it does not specifically address the Veteran's bilateral shoulder or foot disabilities. However, as noted in the Board's September 2019 remand, it raises the issue of secondary service connection for the Veteran's bilateral shoulder and foot disabilities. The Veteran submitted a disability benefit questionnaire (DBQ) in January 2016, where the Veteran was diagnosed with right shoulder strain. This DBQ, however, did not have a nexus opinion attached. In May 2020, Dr. R.B. wrote a positive nexus opinion regarding the Veteran's sleep apnea. In the rationale provided, DR. R.B. wrote that "it is highly possible the back injury caused [the Veteran] to have residuals of [sic] pain which caused poor walking biomechanics. Any pain affected extremity can cause an individual to favor the less painful side, further exacerbating the poor biomechanics and leading to more pain. Favoring one side will cause poor posture thus unusual strain on the joints, muscles and tendons." The Board finds that these statements do not provide the degree of certainty required for medical nexus evidence for the Veteran's bilateral shoulder and foot disabilities specifically. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence). Thus, the Board cannot rely on this opinion to adjudicate the claims. In addition, the Veteran submitted a private medical opinion written by Dr. R.B. in August 2020. In this opinion, Dr. R.B. concluded that the Veteran's bilateral shoulder and foot pain is at least as likely as not secondary to his service-connected back disability. The Board finds that Dr. R.B.'s opinion is not supported by adequate rationale. That is, although Dr. R.B. notes the Veteran's diagnosis of impingement syndrome of the shoulders and plantar fasciitis, the rationale provided does not specifically address how these conditions are related to the Veteran's back disability. Rather, Dr. R.B.'s rationale appears to be focused on the Veteran's pain and she cites to medical literature that talks about the fact that knee pain can cause biomechanics that can cause pain in the rest of the body. Overall, the Board cannot make a fully-informed decision on the issues of service connection for bilateral shoulder and foot disabilities because the record does not have adequate medical nexus opinions. Thus, a remand is necessary before the claims can be adjudicated. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination for his claimed bilateral shoulder disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the Veteran's bilateral shoulder disability at least as likely as not (a 50 percent or greater probability) caused by his military service? Is the Veteran's bilateral shoulder disability at least as likely as not (a 50 percent or greater probability) caused by his service-connected back disability? And Is it at least as likely as not (50 percent or greater probability) that the Veteran's bilateral shoulder disability is aggravated (worsened beyond its natural progression) by his service-connected back disability? In providing the requested opinions, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 2. Schedule the Veteran for a VA examination for his claimed bilateral foot disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the Veteran's bilateral foot disability at least as likely as not (a 50 percent or greater probability) caused by his military service? Is the Veteran's bilateral foot disability at least as likely as not (a 50 percent or greater probability) caused by his service-connected back disability? And Is it at least as likely as not (50 percent or greater probability) that the Veteran's bilateral foot disability is aggravated (worsened beyond its natural progression) by his service-connected back disability? In providing the requested opinions, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? JENNA T. BRANT Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Solomon 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.