Citation Nr: 21070944 Decision Date: 11/27/21 Archive Date: 11/27/21 DOCKET NO. 15-03 777 DATE: November 27, 2021 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1960 to August 1962. He also served in the Puerto Rico Army National Guard from March 1974 to May 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Most recently, in June 2021 the Board remanded this matter for further development. That development having been completed, this matter has returned to the Board for further appellate review. 1. Entitlement to service connection for a right shoulder disability is remanded. 2. Entitlement to service connection for a left shoulder disability is remanded. Unfortunately, another remand is required as there has not been substantial compliance with the directives of the June 2021 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance, rather than absolute compliance, with remand orders). In this regard, the June 2021 remand directed the RO to obtain an addendum opinion addressing the etiology of the Veteran's bilateral shoulder disabilities. The examiner was specifically directed to address the Veteran's contention that the cumulative physical demands of his active duty service caused his bilateral shoulder disabilities. The July 2021 addendum opinion found it was less likely than not that the Veteran's bilateral shoulder disabilities were related to his active duty service. In reaching this opinion, the examiner heavily relied on the Veteran's post-service job in construction as being the cause of his bilateral shoulder disabilities. The examiner stated that the physically demanding nature of construction work would have made the Veteran prone to suffer from bilateral shoulder rotator cuff pathology. The examiner did not explain, however, why the physical demands of the Veteran's active duty service would not have had the same impact on the Veteran's shoulders as his post-service construction work. Additionally, the examiner did not comment on the effect, if any, of the Veteran's active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA) during his twenty two years of Reserve service in the Puerto Rico Army National Guard. Furthermore, the June 2021 opinion was limited to the Veteran's bilateral shoulder rotator cuff tear, and did not address the previously documented diagnoses of bilateral degenerative joint disease. See March 2017 Shoulder and Arm Conditions Disability Benefits Questionnaire; McClain v. Nicholson, 21 Vet. App. 319 (2007). The previous Board remand specifically directed the RO to obtain an opinion as to whether any arthritis was related to the Veteran's in-service stress on his shoulders, as theorized by the Veteran and the January 2013 private clinician. Stegall, 11 Vet. App. 268. In light of the aforementioned reasons, the Board finds the June 2021 addendum opinion inadequate. Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Accordingly, this matter is remanded to obtain an adequate medical opinion, as set forth below. The matters are REMANDED for the following action: 1. Return the claims file to the examiner who provided the June 2021 VA addendum opinion. If that examiner is not readily available, a VA opinion may be obtained by another medical professional with an appropriate background or expertise. The Veteran should not be scheduled for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) unless deemed necessary by the VA medical professional rendering an opinion on this claim. The entire claims file, to include a copy of this REMAND must be made available to the examiner in conjunction with the opinion. The examiner must confirm in the examination reports that he or she has reviewed the folder in conjunction with the examination. The examiner should elicit a full history from the Veteran. After reviewing the file, eliciting a full medical history from the Veteran, conducting an examination of the Veteran, performing any clinically indicated diagnostic testing, the examiner must provide answers to the following: (a) Identify, by diagnosis, all right and left shoulder disorders found to be present, to include bilateral shoulder rotator cuff tear and bilateral degenerative joint disease. (b) For each right and/or left shoulder disorder found, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the disorder had its clinical onset in, or is otherwise related to any incident of service or subsequent periods of ACDUTRA, to include the cumulative impact of carrying heavy loads on his back and shoulders. * In reaching these opinions, the examiner should consider and address the January 2013 private medical opinion which stated that carrying heavy loads on the shoulders and back can put stress on the shoulders and back can put stress on the shoulders, causing inflammation and degenerative changes in the long term. (Continued on the next page) ** If the examiner finds that the Veteran's shoulder disorders are the result of his post-service occupation in construction, he or she must explain why they are discounting the cumulative physical demands of his active service and subsequent periods of ACDUTRA The examiner must provide a complete rationale for all proffered opinions. If the examiner cannot provide the required opinions without resorting to speculation, he or she must provide a complete explanation as to why that is the case and must state whether the inability to provide the required opinions is based on a lack of knowledge among the medical community at large. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. M. Stedman, 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.