Citation Nr: 21077083 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-12 929 DATE: December 28, 2021 REMANDED Entitlement to service connection for a right shoulder disability, to include as secondary to service-connected cervical spine disability, is remanded. Entitlement to service connection for a back disability, to include as secondary to service-connected cervical spine disability, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to April 1971. This matter comes before the Board of Veterans' Appeals (Board) from a February 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied the claims on appeal. In July 2019 and April 2021, the Board remanded this appeal to the Agency of Original Jurisdiction for further evidentiary development. Service connection for a right shoulder disability Service connection for a back disability Unfortunately, further remand is required in this appeal where the record lacks adequate etiology opinions with respect to the Veteran's claimed right shoulder and back disabilities. In the April 2021 remand, the Board specifically directed the AOJ to schedule the Veteran for an examination to obtain opinions as to whether it was at least as likely as not that his current right shoulder or back disabilities were etiologically related to his active service, or caused or aggravated by the service-connected degenerative joint disease of the cervical spine. At a July 2021 VA-contracted examination, the examiner diagnosed degenerative arthritis of the Veteran's back, and glenohumeral joint arthritis and degenerative arthritis of his right shoulder. While the examiner stated that the claimed conditions were less likely than not incurred in, or caused by, a claimed in-service injury, event, or illness, the examiner provided rationales indicating that there was no medical literature that supported a shoulder condition or lower back condition as a complication, injury or symptom related to the cervical spine. The Board finds this rationale inadequatefor both the direct and secondary (causation) service connection opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (a medical examination report must contain clear conclusions with supporting data and a reasoned medical explanation connecting the two). Further, the examiner did not provide any opinion with respect to whether the disabilities were aggravated by the service-connected cervical spine disability. See Allen v. Brown,7 Vet. App. 439, 448 (1995) (holding that secondary service connection is a two-part issue that involves causation and/or aggravation); see also. Stegall v. West, 11 Vet. App. 268, 271 (1998) (a remand by the Board confers on a claimant a legal right to compliance with the remand order). Based on the deficiencies in the opinions provided by the VA-contracted examiner, remand is required to obtain adequate etiology opinions addressing the theories of entitlement presented in the record. Entitlement to a TDIU The TDIU matter is inextricably intertwined with the service connection claims remanded herein. Therefore, the Board must defer consideration of the TDIU claim at this time. See Harris v. Derwinski,1 Vet. App. 181(1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). Accordingly, these matters are hereby REMANDED for the following action: 1. Arrange for the Veteran's claims file to be reviewed by an appropriate VA examiner to obtain new opinions as to the etiology of his claimed back and right shoulder disabilities. The claims file and a copy of this REMAND should be made available to the examiner for review. If the examiner finds that a new examination is warranted in order to provide any requested etiology opinion, arrange for the Veteran to be afforded such examination. If the Veteran is examined, any and all indicated studies and tests deemed necessary by the examiner should be accomplished. After review of the record, and completion of any examination (including any necessary tests and studies), the examiner should: (a.) for each back (to include degenerative arthritis and radiating pain from the cervical spine) and right shoulder disability (to include degenerative arthritis/glenohumeral joint arthritis, impingement syndrome, and radiating pain from the cervical spine) diagnosed during the pendency of this appeal, provide a new opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability), that such disability (a) onset during the Veteran's active service, (b) was manifested within one year after discharge from service, or (3) is otherwise medically-related to his service. (b.) For each back and right shoulder disability diagnosed during the pendency of the appeal that is deemed to not be at least as likely as not etiologically related to the Veteran's service on a direct basis, provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent probability or greater) that such disability was caused, or aggravated (made worse) beyond its natural progression, by the service-connected degenerative joint disease of the cervical spine. In expressing this opinion, the examiner should address the Veteran's frequent complaints of radiating pain from his neck into his right shoulder and back. In addressing the above, the examiner must consider and discuss all pertinent medical evidence, to include evidence of right shoulder bursitis noted as early as in June 1977, evidence of thoracic spine degenerative joint disease diagnosed as early as October 1989, evidence of early degenerative change in the right shoulder shown in March 1990, and evidence of radiating pain from the cervical spine to the shoulders and back over the last several years. The examiner must also consider and discuss all pertinent lay evidence of record, to include the Veteran's assertions as to the nature, onset, and continuity of his claimed right shoulder and back disabilities, including as a result of radiating pain. If lay assertions in any regard are discounted, the examiner should clearly so state, and explain why. The examiner must provide reasons for all opinions. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. Ensure that the VA medical opinions obtained are compliant with these directives and that complete rationale is provided for each conclusion reached. The opinions must include an analysis that is adequate for the Board to consider and weigh against other evidence of record. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for any VA medical examination that may be scheduled may impact the determinations made. 38 C.F.R. § 3.655. The Veteran also is advised that he has the right to submit additional evidence and argument with respect to these matters. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael Wilson, 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.