Citation Nr: 21066805 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 18-27 686 DATE: November 2, 2021 REMANDED Entitlement to service connection for left shoulder condition, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for right shoulder condition, to include as secondary to service-connected PTSD is remanded. Entitlement to service connection for left bicep tendonitis, to include as secondary to service-connected PTSD is remanded. Entitlement to service connection for right bicep tendonitis, to include as secondary to service-connected PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1976 to April 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the proceeding has been associated with the claims file. The Veteran contends that her bilateral bicep tendonitis and bilateral shoulder condition are related to her service-connected PTSD, as she experiences nightmares that cause her to flail and flex her arms and shoulders, resulting in her claimed conditions. The September 2017 VA examination shows the Veteran has a current disability of bilateral shoulder impingement syndrome, bilateral bicep tendonitis, and glenohumeral joint osteoarthritis. The Veteran's private treatment provider opined in a March 2017 letter that her bicep and shoulder disabilities were at least as likely as not proximately due to or the result of her service-connected PTSD. The private treatment provider opined that the Veteran flexes her arms during nightmares in an attempt to protect her throat, resulting in bilateral bicep tendonitis and affecting the long and short attachments in the shoulders. However, in an addendum letter provided in February 2021, the private provider appeared to suggest that a single nightmare caused the Veteran's conditions. The September 2017 VA examiner opined that it was less likely than not that the Veteran's bilateral tendonitis and bilateral shoulder condition were related to her service-connected PTSD, because in his opinion, tendonitis was related to overuse; however, the examiner did not describe this Veteran's activities which would constitute overuse. In order to reconcile the conflicting opinions of record, another opinion should be obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for another VA examination. The examiner should address the following: (a.) Whether the Veteran is diagnosed with any current bicep and/or shoulder disability that is consistent with a sudden onset. (b.) If the Veteran's bicep and shoulder disabilities are consistent with sudden onset, the likely trigger of that onset should be identified. (c.) If the Veteran's disabilities are more properly considered to be a consequence of overuse, the examiner should opine as to the activities which constitute overuse. (d.) If arm thrashing during nightmares is implicated, the examiner (or other appropriate clinician, if necessary) should address whether the Veteran's PTSD nightmares can cause arm thrashing, and if so, whether it is at least as likely as not that the Veteran's arm thrashing caused or aggravated the Veteran's bicep and shoulder disabilities. The examiner/s should provide a complete rationale for any opinions expressed and should cite to the specific evidence of record or other medical resources as appropriate. 2. Thereafter, the Veteran's claim should be readjudicated based on the entirety of the evidence. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Geer, Vanessa V. 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.