Citation Nr: 21077537 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 16-26 466 DATE: December 30, 2021 REMANDED Entitlement to service connection for a right shoulder disability, characterized as tendinosis of the rotator cuff and degenerative change of the acromioclavicular joint, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from February 2005 to September 2005, from March 2006 to February 2007, from August 2008 to February 2009, and from February 2009 to September 2009. He also has service in the Army Reserves. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was most recently before the Board in August 2021 when it was remanded to the Agency of Original Jurisdiction (AOJ) for additional development. For the reasons discussed below the Board is unable to conclude that the AOJ substantially complied with prior remand directions. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Entitlement to service connection for a right shoulder disability, characterized as tendinosis of the rotator cuff and degenerative change of the acromioclavicular joint, is remanded. Pursuant to the August 2021 Board remand, an addendum VA opinion was obtained in September 2021. In part, the examiner was asked to determine whether the Veteran had a clear and unmistakable preexisting injury to the right shoulder prior to entry into service, specifically referencing a March 2000 shoulder injury and surgery. The examiner provided a negative opinion as to direct service connection; however, the examiner did not address whether the Veteran had a clear and unmistakable preexisting injury, or if such an injury was aggravated by service. Additionally, the rationale provided did not address the March 2000 injury. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board sincerely regrets the additional delay occasioned by multiple remands. However, the Board errs when it fails to ensure substantial compliance with a Board remand. Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order). Where the Board fails to ensure substantial compliance, remand is appropriate. Stegall, 11 Vet. App. at 271. The matters are REMANDED for the following action: Obtain an addendum opinion to determine the nature and etiology of the Veteran's right shoulder disability, characterized as tendinosis of the rotator cuff and degenerative change of the acromioclavicular joint. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran's service treatment records, post-service medical records, and statements. After examining the Veteranif deemed necessary by the examinerand considering his pertinent medical history and lay statements regarding his reported symptoms, the examiner must provide a thoroughly reasoned opinion as to each of the following: (a) Whether the Veteran's right shoulder disability clearly and unmistakably pre-existed service. In rendering this opinion, the examiner must specifically discuss the Veteran's March 2000 shoulder injury and surgery and must provide a clear answer to the question of whether the Veteran's pre-existing right shoulder injury resolved prior to his period of active service. (b) If the examiner determines that the Veteran's right shoulder disability clearly and unmistakably pre-existed service, they must provide a thoroughly reasoned response as to whether the right shoulder disability clearly and unmistakably was not aggravated (worsened beyond its natural progression) by service. (c) If the answer to all the above questions is No, if the examiner determines that the disability did not clearly and unmistakably pre-exist service, the examiner must state whether it is at least as likely as not (50 percent probability or greater) that the Veteran's right shoulder disability originated during or is otherwise etiologically related to the Veteran's active-duty service. (d) If the answer to all the above questions is No, the examiner must opine as to whether it is at least as likely as not (a 50 percent probability or greater) that his right shoulder disability was caused by his service-connected left shoulder disability. (e) Whether it is at least as likely as not (a 50 percent probability or greater) that his right shoulder disability was aggravated by his service-connected left shoulder disability Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The examiner is advised that a finding that a disability was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Javed, 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.