Citation Nr: 21071044
Decision Date: 11/29/21	Archive Date: 11/29/21

DOCKET NO. 09-31 223
DATE: November 29, 2021

REMANDED

1.  Entitlement to service connection for a left shoulder disability, to include as secondary to service-connected lumbosacral strain is remanded.

2.  Entitlement to service connection for left knee disability, to include as secondary to service-connected lumbosacral strain is remanded.

3.  Entitlement to service connection for a left arm disability (left elbow strain/left upper extremity ulnar neuropathy), to include secondary to service-connected lumbosacral strain is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 1974 to March 1977 in the United States Army, to include active-duty service in the Vietnam Era.

The claims were most recently before the Board in February 2021. Unfortunately, there has not been substantial compliance with the remand directives regarding the and another remand is required.  Stegall v. West, 11 Vet. App. 268, 271 (1998).

1.  Entitlement to service connection for a left shoulder disability, to include as secondary to service-connected lumbosacral strain.

2.  Entitlement to service connection for left knee disability, to include as secondary to service-connected lumbosacral strain.

3.  Entitlement to service connection for a left arm disability (left elbow strain/left upper extremity ulnar neuropathy), to include secondary to service-connected lumbosacral strain.

The claims must be remanded to obtain adequate opinions as to whether the claimed disabilities are secondary to the Veteran's service-connected back disability.

The January 2021 VA medical opinions are inadequate.  With respect to secondary causation there was no opinion corresponding to the the left knee disability.  The causation opinions offered for the left shoulder and left arm merely state that the medical records do not support that these two conditions are caused by the service-connected back condition without further rationale.  With respect to aggravation, the opinions all utilized the incorrect standard to assess aggravation and there was no attempt by the AOJ to obtain the correct addendum opinions, despite sepcific instruction contained in the Board's previous remand directives.

The matters are REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician regarding the likely etiology of the Veteran's left shoulder, left knee and left arm disabilities. Copies of all pertinent records must be made available to the examiner for review. Based on the examination and review of the record, the examiner must answer the following:

(a) Is it at least as likely as not that the left shoulder disability is (i) proximately due to service-connected lumbosacral strain or (ii) aggravated by (defined as any increase in disability) the service-connected lumbosacral strain?

(b) Is it at least as likely as not that the left knee disability is (i) proximately due to service-connected lumbosacral strain or (ii) aggravated by (defined as any increase in disability) the service-connected lumbosacral strain?

(c) Is it at least as likely as not that the left arm disability is (i) proximately due to service-connected lumbosacral strain or (ii) aggravated by (defined as any increase in disability) the service-connected lumbosacral strain?

Provide a rationale to support all opinions provided.

2.  The AOJ must 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	P.S. McLeod

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.