Citation Nr: 21073635 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 17-46 531A DATE: December 9, 2021 REMANDED Service connection for right shoulder degenerative joint disease is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1961 to May 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This appeal has been remanded on three occasions, most recently in July 2021. The development has been completed and the appeal has been returned to the Board for further appellate review. This appeal was remanded in October 2018 for an addendum medical opinion that considered subsequent relevant medical and lay evidence. In December 2020, it was remanded again to consider the Veteran's allegation that he had steroid shots in his right shoulder for the past 30 years. An examination was scheduled for March 2021, but the Veteran failed to report for it. In June 2021, the Board found he had good cause for his absence and remanded the matter for an examination. In September 2021, the Veteran underwent a VA examination for his right shoulder disability. Service connection for right shoulder degenerative joint disease is remanded. The Veteran asserts that his current right shoulder degenerative joint disease is related to an in-service injury in 1963 in which he fell. See May 2018 Board hearing testimony. He asserts that he had pain in his shoulder due to the injury, and the disability got progressively worse over the years. He also testified that he started taking a prescription medication for his shoulder after separation and that he began having shots in his shoulder in the 1970s. The Veteran reported receiving steroid injections over the past 30 years for his right shoulder. The evidence shows that while he received injections, they were not for his right shoulder. Private medical records from 1998 through 2007 note that he received periodic injections in his left and right lower extremities and his back, but not his right shoulder. A March 1998 record from Dr. D. H. noted a Celestone injection for the Veteran's back. June 2000, June 2001, June 2002, March 2004, June 2004, July 2004, January 2005, and June 2005 treatment reports from Dr. D. H. showed a prescription for Kenalog injections for knee pain. In March 2004, he reported to Dr. D. H. that NSAIDs were not working and that he wanted injections. In August 2009, Dr. A. U. prescribed Cortisone injections for the Veteran's knees. The medical evidence showing what body part the injections were for is more probative than the Veteran's statement that he received steroid injections for his right shoulder. His lay assertion is directly contradicted by the record, which states the injections were in his lower extremities and back. Therefore, it is not credible. However, in November 2013 and at his hearing, the Veteran asserted that the steroid injections made him gain weight. The medical evidence of record indicates that obesity may be the cause of his shoulder disability. Although the steroid injections were not for his shoulder, his left knee, right knee, and back disabilities are all service-connected. Obesity may act as an "intermediate step" between a service-connected disability and a current disability that may be service-connected on a secondary basis under 38 C.F.R. 3.310(a). In this case, the record shows that the Veteran received steroid injections for his now service-connected disabilities for many years, and that he believes that made him gain weight. The theory of secondary service connection via obesity as an intermediate step has been raised by the record. Garner v. Tran, 33 Vet. App. 241 (2021). An addendum opinion is needed. The matter is remanded for the following actions: 1. Provide the Veteran's claims file to a suitable clinician so a supplemental opinion may be provided for the Veteran's right shoulder disability. The entire claims file and a copy of this remand must be made available to the clinician for review. A physical examination of the Veteran or telehealth examination is only required if deemed necessary by the clinician. The examiner must provide opinions as to the following: a. Determine whether the steroid injections received periodically from 1998 through 2009 for the Veteran's service-connected knee and back disabilities caused or aggravated obesity. b. If yes, determine whether the obesity as a result of the injections was a substantial factor in causing his right shoulder disability. c. If yes, determine whether the right shoulder disability would not have occurred but for the obesity caused or aggravated by the steroid injections for his service-connected back and knee disabilities. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Readjudicate the claim. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Rocktashel, 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.