Citation Nr: 21072494 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 17-51 271 DATE: December 3, 2021 REMANDED Entitlement to service connection for right rotator cuff tendonitis and right os acromiale (claimed as right shoulder arthritis) is remanded. REASONS FOR REMAND The Veteran had active service in the United States Air Force from October 2008 to May 2013, including service in Southwest Asia. This matter comes to the Board of Veterans' Appeals (the Board) following a May 2017 rating decision in which the Agency of Original Jurisdiction (AOJ) denied service connection for a right shoulder condition (claimed as right shoulder arthritis). The Board previously remanded this claim in June 2019, directing the AOJ to obtain a Department of Veterans Affairs (VA) medical opinion regarding the etiology of the Veteran's right shoulder condition. 1. Entitlement to Service Connection for Right Rotator Cuff Tendonitis and Right Os Acromiale The Veteran asserts that he is entitled to service connection for a right shoulder condition, currently diagnosed as right rotator cuff tendonitis and right os acromiale. He contends that his right shoulder pain began in 2011 during his deployment in Kuwait and has been constant since then. The Veteran received a VA examination regarding the nature and etiology of his right shoulder condition in August 2017. The examiner diagnosed the Veteran with bilateral rotator cuff tendonitis and bilateral os acromiale, explaining that os acromiale is a developmental condition that "can predispose a person to having an impingement syndrome which would place the supraspinatus tendons (involving each shoulder) at risk of injury." During his October 2020 VA examination, the examiner once again diagnosed the Veteran with right rotator cuff tendonitis and right os acromiale. He opined that the Veteran's right shoulder conditions were less likely than not incurred in or caused by service because they were due, in part, to a developmental deformity involving both shoulders. An addendum opinion is necessary because the October 2020 VA examiner's conclusion regarding developmental conditions is incomplete. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA provides an examination, it must ensure that the examination is adequate). VA's General Counsel has indicated that there is a mutually exclusive distinction between a congenital or developmental "disease" and a congenital or developmental "defect" for the purposes of service connection. Service connection may be granted for a congenital disease where the disease first manifested during service or where it preexisted service but was worsened beyond its normal progression as a result of service. See VAOPGCPREC 82-90 (1990); VAOPGCPREC 67-90 (1990). However, while congenital or developmental defects are not service connectable in their own right, service connection may be granted for additional disability due to disease or injury superimposed upon a defect during service. VAOPGCPREC 82-90 (1990). Distinguishing between a developmental disease and a developmental defect turns on whether the condition is dynamic or static in nature. A developmental disease is dynamic, "capable of improving or deteriorating," and "any worseningany change at allmight demonstrate that the condition is a disease." Quirin v. Shinseki, 22 Vet. App. 390, 394-95 (2009). Conversely, a defect is "structural or inherent abnormalities or conditions which are more or less stationary in nature." VAOPGCPREC 82-90 (1990). As the August 2017 VA examination refers to os acromiale as a "developmental condition" and the October 2020 VA examination refers to it as a "developmental deformity," the Board concludes that an addendum opinion is necessary to determine whether the Veteran's right os acromiale is a developmental disease or a developmental defect. Furthermore, if his right os acromiale is determined to be a developmental defect, then an opinion is needed to address whether his currently diagnosed right rotator cuff tendonitis or any other right shoulder condition is due to a superimposed injury during service. If the Veteran's right os acromiale is found to be a developmental disease, on the other hand, an opinion should be obtained to address direct service connection. The matters are REMANDED for the following action: 1. Obtain an addendum opinion to the October 2020 VA examination. The Veteran's claims file must be made available to the examiner. Following review of the claims file, with any necessary examination and testing, the examiner should opine on the following: Is the Veteran's right os acromiale a congenital/developmental defect or a congenital/developmental disease? The examiner is advised that a disease generally refers to a condition that is considered capable of improving or deteriorating, while a defect is generally not considered capable of improving or deteriorating. i. If the examiner determines that right os acromiale is a congenital/developmental defect, explain whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran now has additional disability due to an in-service disease or injury superimposed upon his right os acromiale. ii. If the examiner determines that right os acromiale is a congenital/developmental disease, opine on whether the disease (A) clearly and unmistakably existed prior to his active service and (B) clearly and unmistakably underwent no increase in severity as a result of his active service. The examiner should consider the Veteran's report that his right shoulder pain began in 2011 during his deployment and has been constant since then, as well as his reports of falling while training with his weapon during service. 2. Provide a rationale for all opinions proffered. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.M. Sachs, 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.