Citation Nr: 21073341 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 15-31 033A DATE: December 8, 2021 ORDER Entitlement to service connection for right bicep tendinitis is granted. REMANDED Entitlement to service connection for a chronic cervical spine disability, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for cervical radiculopathy, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a right hip disability, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for a left hip disability, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for left wrist carpal tunnel syndrome, to include as secondary to service-connected disabilities, is remanded. FINDING OF FACT The Veteran's right bicep tendinitis is etiologically related to an injury during an active period of training (ACDUTRA). CONCLUSION OF LAW The criteria for service connection for right bicep tendinitis are met. 38 U.S.C. §§ 101, 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Marine Corps from January 2003 to January 2008 with subsequent periods of ACDUTRA. This case comes before the Board of Veterans' Appeals (Board) on appeal from May 2013 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested to appear at a videoconference hearing before the Board in a January 2014 Notice of Disagreement and September 2015 substantive appeal. In April 2018, the Veteran withdrew his hearing request and asked for the Board to issue a decision based on the current evidence of record. Despite the Veteran's hearing withdrawal, in October 2018 and September 2021, his representative asked for the Board to remand the Veteran's case for a hearing. Because the Veteran and his representative had presented inconsistent requests with respect to a hearing, the Board sent the Veteran a hearing clarification letter in October 2021. He responded by telephone in November 2021 and stated that he did not wish to appear at a hearing and wanted a decision as soon as possible. The Board therefore finds that the Veteran has withdrawn his request for a hearing and will proceed with a decision in this case. 38 C.F.R. § 20.704(e). The Board also finds that a claim for service connection for cervical radiculopathy is included in the current appeal. This claim has not been formally adjudicated by the RO, but was addressed in medical evidence submitted by the Veteran in October 2019. The criteria for the evaluation of disabilities of the spine provide that associated objective neurological abnormalities are a component of the underlying spinal condition. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5343. Therefore, a claim for service connection for cervical radiculopathy is part of the underlying claim for a cervical spine disability and is also before the Board. 1. Entitlement to service connection for right bicep tendinitis. The Veteran contends that service connection is warranted for a right bicep disability (claimed as a right arm and elbow condition) as it was incurred during a period of ACDUTRA in January 2012. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for disability resulting from disease or injury incurred in or aggravated while performing ACDUTRA. 38 U.S.C. §§ 101(24), 106, 1110, 1131. The Board finds that all three elements of service connection are present in this case. Right bicep tendinitis was diagnosed by a VA examiner in May 2013, and similar findings of epicondylitis and bursitis were made by the Veteran's VA and private treating physicians in March 2012 and April 2018, respectively. Service treatment records document complaints of a painful muscle pull in the Veteran's right forearm and elbow in January 2012 during a period of ACDUTRA at Camp Lejeune, North Carolina. The examining provider specifically noted that the Veteran was on active duty and diagnosed lateral epicondylitis (tennis elbow). Additionally, the May 2013 VA examiner provided a medical opinion in favor of a link between the Veteran's injury during ACDUTRA and his current right bicep tendinitis. A similar medical opinion was provided by the Veteran's private physician in May 2013. The Board therefore finds that service connection is warranted for the Veteran's right bicep tendinitis. REASONS FOR REMAND 1. Entitlement to service connection for a chronic cervical spine disability, to include as secondary to service-connected disabilities. 2. Entitlement to service connection for cervical radiculopathy, to include as secondary to service-connected disabilities. 3. Entitlement to service connection for a right hip disability, to include as secondary to service-connected disabilities. 4. Entitlement to service connection for a left hip disability, to include as secondary to service-connected disabilities. 5. Entitlement to service connection for left wrist carpal tunnel syndrome, to include as secondary to service-connected disabilities. The Board regrets additional delay in this case, but finds that a remand is necessary to further develop the record. The record contains medical opinions weighing for and against service connection for the claimed cervical spine, bilateral hip, and left carpal tunnel syndrome disabilities, but the Board finds that all the opinions are insufficient and lacking in probative value. Thus, additional medical opinions are required. The record contains VA medical opinions dated in April 2013 and February 2015 addressing the etiology of the Veteran's claimed disabilities. The April 2013 VA examiner concluded that the Veteran did not have a left wrist carpal tunnel syndrome and did not issue an opinion addressing its etiology; the other provided opinions pertaining to the cervical spine and bilateral hips are inadequate as they are not accompanied by any explanatory rationale. Turning to the February 2015 VA medical opinions, while they include a rationale, the examiner only addressed whether the Veteran's claimed disabilities were caused or aggravated by the Veteran's service-connected low back disability. The examiner did not address a possible relationship between the Veteran's disabilities and his active service or his other service-connected disabilities, including his foot and knee disabilities. As such, they are not sufficient for decision purposes. The Veteran also submitted private medical opinions in support of his claims in April 2018. These opinions, while ostensibly based on a full review of the Veteran's records, appear to be based solely on the Veteran's reported history of neck, hip, and left wrist pain beginning in active service and continuing to the present day. A similar history was presented to VA in an April 2018 correspondence from the Veteran; however, the Board notes that this history of continuous pain since service is inconsistent with the other evidence of the record, including the Veteran's contemporaneous statements during and after service while seeking medical treatment. As the credibility of the Veteran's April 2018 statements and history are in question, the April 2018 private medical opinions based on them are of reduced probative value. The Board also notes that the April 2018 private medical opinions do not include a rationale supporting the conclusion that the claimed disabilities are secondary to the Veteran's other service-connected conditions. The Board therefore finds that the record does not contain adequate medical opinions addressing the etiology of the disabilities on appeal. A remand is therefore necessary to obtain additional medical opinions. The matters are REMANDED for the following action: Obtain addendum opinions from an appropriate clinician(s) addressing the etiology of the Veteran's cervical spine disability, cervical radiculopathy, bilateral hip disabilities, and left wrist carpal tunnel syndrome. The examiner should determine the following: (a) Whether the Veteran's claimed disabilities are at least as likely as not related to the Veteran's active service as an aircraft electrical systems technician; and, (b) Whether the Veteran's claimed disabilities are proximately due to or aggravated by the Veteran's service-connected thoracolumbar muscle strain, knee strains, ankle strains, flat feet, bunions, and plantar fasciitis and any accompanying gait changes. The examiner must address the aggravation prong of the secondary service connection opinion. If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation. A full rationale must be provided. The clinician is informed that service records are negative for complaints or treatment pertaining to the Veteran's claimed neck, hip, and left wrist disabilities. His spine, upper, and lower extremities were all normal upon physical examination for separation in October 2007. The Veteran has reported his service duties included many hours of standing on hard surfaces, repetitive hand motions, holding and lifting heavy weights, and wearing a heavy helmet. The type of duties described by the Veteran are consistent with his in-service work as an aircraft electrical systems technician. Post-service records document complaints of left wrist pain beginning in March 2012, with the earliest reports of neck and hip pain dating from the Veteran's claims for service connection in January 2013. The Veteran contends that service connection is warranted on both a direct and secondary basis for all his claimed disabilities. Regarding his secondary service connection claims, a private doctor noted in July 2010 that the Veteran modified the way he stands and walks due to his feet, ankle, knee, and back disabilitiesthough the Veteran's gait was described as normal in December 2015 and March 2020. The February 2015 VA examiner also found that the Veteran did not have a chronic antalgic gait. The record contains several medical opinions addressing the etiology of the Veteran's claimed disabilities with VA opinions dated in April 2013 and February 2015 and private opinions submitted in April 2018. However, the Board has determined that none of the opinions are sufficient for decision purposes. In providing the requested opinions, the clinician should consider the Veteran's reported injuries and symptoms in service and thereafter. If there is any medical reason to accept or reject the proposition that the Veteran's reported injuries and symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the Veteran's reports about his injuries and symptoms align with how the disabilities are known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? (Continued on the next page) The need for additional examination of the Veteran is left to the discretion of the clinician(s) rendering the requested opinions. R. Behlen Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Department of Veterans Affairs 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.