Citation Nr: 21064806 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 20-28 280 DATE: October 21, 2021 REMANDED Entitlement to service connection for a bilateral shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from September 1966 to September 1977, with additional periods of active duty for training in the Naval Reserve. This matter comes before the Board of Veterans Appeals' (Board) from a November 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Board reopened the previously-denied claim of entitlement to service connection for a left shoulder disability and remanded the issue of service connection for a bilateral shoulder disability for the RO to obtain an updated examination and etiology opinion. In so doing, the Board found the October 2018 etiology opinion inadequate for failure to consider the Veteran's reports of strain to his shoulders caused by the cumulative impact of heavy lifting in service. An updated examination and etiology opinion were obtained in July 2021. The July 2021 examiner based his negative etiological opinion on the fact that the Veteran's service treatment records do not "show any treatment or diagnosis for a shoulder condition while veteran was active in the service." This rationale is inadequate, because it is the same rationale used in the October 2018 opinion that was already deemed inadequate by the Board. It is additionally inadequate because it fails to include a discussion of the "aggregate effect of physical strains or wear and tear" of performing in-service duties as instructed by the March 2021 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998) (a remand confers upon the claimant, as a matter of law, the right to compliance with the remand directives). Furthermore, the Board requested that the examiner identify all shoulder disabilities and "[i]f any previously documented diagnoses are no longer or otherwise not felt to apply, the examiner must explain why, citing to the pertinent diagnostic criteria." The examiner failed to do this. In this regard, the October 2018 examiner identified bilateral rotator cuff tear as the only shoulder disability and the July 2021 examiner identified only bilateral rotator cuff hydroxyapatite deposition without explaining whether rotator cuff tear was still an applicable diagnosis. For these reasons, remand is warranted to obtain an addendum opinion. Updated VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, secure any outstanding pertinent private treatment records. 3. Then obtain an addendum opinion from the examiner who conducted the July 2021 shoulder examination, if available. A new examination is not needed unless the examiner determines otherwise, in which case the examiner must so indicate, and a new examination must be scheduled. The examiner is asked to review the claims file, to include any updated records obtained pursuant to (1.) and (2.) above, and the October 2018 and July 2021 shoulder examinations and corresponding etiology opinions. After conducting the necessary review, the examiner is asked to address the following: (a.) Identify all diagnosed bilateral shoulder disabilities present since September 2007, even if resolved, to include bilateral rotator cuff hydroxyapatite deposition disease and bilateral rotator cuff tear. If a diagnosis of bilateral rotator cuff tear as identified on the October 2018 examination report is not valid, please explain why. (b.) For each disability so diagnosed, please opine as to whether it is at least as likely as not (50 percent probability or greater) that such disability was caused by or is related to the cumulative impact of physical strains, wear and tear, overhead work, repetitive movements, and heavy lifting while performing his active service military duties as an electrician, which included service aboard ships. The examiner must accept as true the Veteran's credible reports of heavy lifting, repetitive movements, overhead work, and physical strains in service as an electrician; the onset of bilateral shoulder pain in service; and bilateral shoulder pain that has persisted since service, despite the absence of documentation of the same. The examiner must accept these credible reports as true and opine whether a connection to service is "medically plausible" based on the same. Failure to accept the above statements as true will render the opinion inadequate. Basing a negative opinion on the lack of documented complaints and treatment in service will render the opinion inadequate. Please provide a robust and detailed rationale based on medical principles to support any conclusions reached. If unable to opine without speculation, please support your conclusion in this regard. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. deBruyn, 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.