Citation Nr: 21065107 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 13-06 582A DATE: October 25, 2021 REMANDED Entitlement to service connection for a right shoulder disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected disabilities, is remanded. Preliminary Matters The Veteran served on active duty from February 1978 to August 1992. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2016, the Veteran presented testimony at a hearing before a Veterans Law Judge (VLJ), who has since left the Board. A transcript of the hearing is of record. Following the October 2016 hearing, the issues on appeal were remanded by the Board in October 2017. At that time, the Board also remanded the issues for entitlement to service connection for a lumbar spine disorder, left ankle disorder, psychiatric disorder, and asthma. In an April 2020 rating decision, the RO granted service connection for a lumbar spine disorder, left ankle disorder, psychiatric disorder, and asthma. As such, those issues are no longer before the Board for consideration. In December 2020, the Veteran testified in a virtual hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. In March 2021, the Board remanded the remaining issues for further development. In a June 2021 rating decision, the RO granted service connection for a left elbow disorder, and that issue is no longer before the Board. The issue of entitlement to a total disability evaluation for individual unemployability is in a separate appellate stream under the Appeals Modernization Act (AMA). That issue will be the subject of a separate Board decision. REASONS FOR REMAND Although the Board regrets the additional delay, further development is required prior to adjudication of the claims for entitlement to service connection for a right shoulder disorder, and right and left knee disorders. As it pertains to all the issues on appeal, the Board finds that a remand is warranted in order to obtain adequate medical opinions with complete rationale that properly address the theories of entitlement to direct and service connection. See Stegall v. West, 11 Vet. App. 268 (1998). A VA medical opinion will be considered adequate if it (1) is based upon consideration of the Veteran's prior medical history, (2) describes the disability in sufficient detail so that the Board's "'evaluation of the claimed disability will be a fully informed one,'" Ardison v. Brown, 6 Vet. App. 405, 407 (1994) (quoting Green v. Derwinski, 1 Vet. App. 121, 124 (1991)), and (3) "supports its conclusion with an analysis that the Board can consider and weigh against contrary opinions." Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran asserts that the diagnosed right shoulder, and right and left knee disorders are related to service, including his military occupational specialty (Air Defense Crewman Artillery), which required him to lift, pull, and load heavy missiles. He also indicated that he was required to march with a heavy rucksack. See Board Hearings, dated October 2016 and December 2020. The Board finds that the June 2021 VA examination did not adequately address the Veteran's contentions regarding the effects of marching with a heavy rucksack and working with missiles on the development of his right shoulder, right and left knee disorders. See Miller v. Wilkie, 32 Vet. App. 249 (2020) (stating that a VA medical opinion lacks probative value when the examiner fails to address a veteran's lay reports of his medical history and symptoms). Alternatively, the Veteran contends that the diagnosed right shoulder, and right and left knee disorders are due to his service-connected disabilities, spine and radiculopathy disabilities, which have caused him to fall. Notably, the Veteran is service connected for degenerative arthritis of the spine and intervertebral disc syndrome (rated as 40 percent disabling), left lower extremity radiculopathy (rated as 60 percent disabling), and right lower extremity radiculopathy (rated as 10 percent disabling). The Veteran's left lower extremity radiculopathy disability has been rated as "severe" incomplete paralysis of the sciatic nerve root. Additionally, he has been shown to have a propensity for falling as a result of left lower extremity weakness. See e. g., November 2020 VA peripheral nerves examination report (Veteran stated that he used a walker "due to occasional falls from left leg weakness."); see January 2020 VA treatment record (where the Veteran reported "falls secondary to left leg "giving out" without warning."); see also January 2020 neurology consult note (Veteran was noted to have a "tendency to fall" with serious fall in 2017 and other falls in 2018 and 2020); see also February 2017 VA treatment note (Veteran landed on his "knees/palms/elbows" after left leg gave out on him); see March 2020 VA orthopedic note (indicated that the Veteran had sustained "multiple falls" since July 2019). In a March 2016 VA treatment record, the Veteran was advised that he should undergo a right shoulder MRI due to a history of falling since his last surgery. The Board finds that the June 2021 VA examination did not provide adequate rationale to substantiate the opinion regarding secondary service connection. On remand, VA medical examinations should be obtained that properly address the Veteran's right shoulder and bilateral knee disorders. The examiner should specifically address whether any of the Veteran's claimed orthopedic disorders are secondary to his service-connected disabilities, to include any associated falls. The current VA examination reports and opinions of record do not adequately address these contentions. As such, a remand is required. The matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA right shoulder examination. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. After review of the record, the examiner is asked to respond to the following: (a) A complete history should be elicited from the Veteran regarding his propensity to fall. (b) List all current diagnoses pertaining to the right shoulder. *The examiner is advised that pain may constitute a disability if it produces functional limitation or impairment without identification of the underlying cause of pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). (c) Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right shoulder disorders were incurred in service or are otherwise related to it, to include marching with a heavy rucksack or lifting, pulling, or loading missiles? *The examiner MUST address the Veteran's lay statements of marching with a heavy rucksack and lifting, pulling and loading missiles in service. (d) If the Veteran's right shoulder disorder(s) is not directly related to service, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right shoulder disorder(s) is either caused or aggravated by the service-connected lumbar spine and/or bilateral lower extremity radiculopathy disabilities, to include falling due to left leg weakness. *The examiner MUST address the Veteran's history of falling as due to left leg weakness and "giving way" as documented in VA treatment records. *The examiner is advised that for secondary service connection, "aggravation" need not be permanent in nature. Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019). (e) A complete, clearly stated rationale for the conclusions reached must be provided. 2. Schedule the Veteran for a VA bilateral knee examination. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. After review of the record, the examiner is asked to respond to the following: (a) A complete history should be elicited from the Veteran regarding his propensity to fall. (b) List all current diagnoses pertaining to the right and left knee. *The examiner is advised that pain may constitute a disability if it produces functional limitation or impairment without identification of the underlying cause of pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). (c) Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right and left knee disorders were incurred in service or are otherwise related to it, to include marching with a heavy rucksack or lifting, pulling, or loading missiles. *The examiner MUST address the Veteran's lay statements of marching with a heavy rucksack and lifting, pulling, and loading missiles in service. (d) If the Veteran's knee disorder(s) is not directly related to service, provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right and/or left knee disorders are either caused or aggravated by the service-connected lumbar spine and/or bilateral lower extremity radiculopathy disabilities, to include falling due to left leg weakness. *The examiner MUST address the Veteran's history of falling as due to left leg weakness and giving way as documented in VA treatment records. *The examiner is advised that for secondary service connection, "aggravation" need not be permanent in nature. Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019). (e) A complete, clearly stated rationale for the conclusions reached must be provided. 3. Then, readjudicate the claims on appeal. . S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Beach, 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.