Citation Nr: 21064900 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 15-24 550 DATE: October 21, 2021 REMANDED Entitlement to service connection for degenerative joint disease of the left knee, status post total knee replacement, is remanded. Entitlement to service connection for degenerative joint disease of the right knee is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for an acquired psychiatric disability, to include as secondary to knee disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1976 to November 1977. In June 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The claims were previously before the Board in August 2018. There has not been substantial compliance with the Board's remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). As noted in the prior Board remand, the Veteran is in receipt of compensation benefits for degenerative disc disease, degenerative arthritis of the cervical spine with cervical stenosis and cervical fusion under 38U.S.C. §1151, effective September 30, 2015, based upon a separate claim for benefits based upon 38 U.S.C. § 1151. However, as the Veteran is not in receipt of benefits for the period prior to September 30, 2015, and the Veteran's claim for the entitlement to service connection for degenerative joint disease of the cervical spine originated prior to September 30, 2015, the claim remains on appeal. 1. Entitlement to service connection for degenerative joint disease of the left knee, status post total knee replacement, is remanded. 2. Entitlement to service connection for degenerative joint disease of the right knee is remanded. 3. Entitlement to service connection for a left shoulder disability is remanded. 4. Entitlement to service connection for a right shoulder disability is remanded. 5. Entitlement to service connection for a cervical spine disability is remanded. The claims must be remanded again because the May 2021 VA opinions obtained on remand are inadequate. The examiner concluded that the Veteran's knee, shoulder, and neck disabilities were not the result of the Veteran's service. However, the rationale provided relied solely upon a lack of complaints of documented complaints in service and a normal separation examination. The Veteran has competently asserted that she had knee and shoulder problems in service and since. 6. Entitlement to service connection for an acquired psychiatric disability, to include as secondary to knee disabilities, is remanded. The claim must be remanded again because the May 2021 VA medical opinion is inadequate. The examiner did not offer an opinion regarding whether a psychiatric disability was related to the service and found that the claimed condition was less likely than not secondary to the Veteran' service-connected disabilities. The examiner did not identify a current DSM-5 diagnosis of a psychiatric disability but the report is internally inconsistent. The examiner said that medical records showed treatment for a disorder in 2007 but that the symptoms had dissipated after treatment. However, the examiner also noted treatment for depression from 2014 to 2020, but did not discuss whether the Veteran had any psychiatric disability during the appeal period. On remand, any outstanding VA and private treatment records should be obtained. See 38 C.F.R. § 3.159. The Veteran receives consistent treatment from VA, but the last records are dated in April 2020. She submitted private treatment records in October 2020 and in November 2020 said she would submit more. There were no records received after the October 2020 submission. In October 2020 additional private treatment records were submitted by the Veteran. In November 2020, she called to indicate that additional medical evidence was being submitted by mail, but there was no further submission. She should be asked to identify all treatment providers and attempts should be made to obtain any records. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file the Veteran's VA treatment records for the period from April 2020 to the present. 2. Contact the Veteran and request that she identify all private treatment providers. Thereafter, after obtaining any necessary authorization, attempt to obtain and associate with the claims file all treatment records regarding the Veteran from the providers identified by the Veteran. 3. After completion of the above, obtain a medical opinion regarding the nature and etiology of the Veteran's bilateral knee, bilateral shoulder, and neck disabilities. Copies of all pertinent records must be made available to the examiner for review. If examination is deemed necessary to respond to the questions presented, one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). The examiner must answer the following: (a) Is it at least as likely as not that any diagnosed knee, shoulder or neck disability is related to an in-service injury, event, or disease, including the Veteran's reported work as a supply clerk? Why or why not? A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 4. Schedule the Veteran for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of any acquired psychiatric disability, to include depressive disorder, found to be present. Copies of all pertinent records must be made available to the examiner for review. The examiner must answer the following: (a) Identify all psychiatric disabilities diagnosed since November 2010. (b) For each psychiatric disability diagnosed since November 2010, is it at least as likely as not related to an in-service injury, event, or disease, including the Veteran's reported harassment in service? Why or why not? (c) If the answer to (b) is no, is it at least as likely as not that any psychiatric disability diagnosed since November 2010 is (1) proximately due, or (2) aggravated by the Veteran's bilateral knee disabilities (defined as any increase in disability)? Why or why not? A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 5. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. LARKIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Robert J. Burriesci, 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.