Citation Nr: 21005972 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-61 799 DATE: February 3, 2021 ORDER Entitlement to service connection for residuals of a left hip dislocation is denied. Entitlement to service connection for a lumbar spine condition is denied. Entitlement to service connection for radiculopathy of the bilateral lower extremities, to include as secondary to degenerative joint disease of the lumbar spine, is denied. REMANDED Entitlement to service connection for a cervical spine condition is remanded. Entitlement to service connection for left rotator cuff tear with traumatic arthritis, bone spur on rotator cuff, and nerve impingement syndrome is remanded. FINDINGS OF FACT 1. The preponderance of the probative evidence is against finding that residuals of a left hip dislocation began during active service or are otherwise related to an in-service injury or disease. 2. The preponderance of the probative evidence is against finding that a lumbar spine condition began during active service or is otherwise related to an in-service injury or disease. 3. The Veteran’s radiculopathy of the bilateral lower extremities is secondary to degenerative joint disease of the lumbar spine, a condition that has not been service-connected, and is not otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of a left hip dislocation are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a lumbar spine condition are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for radiculopathy of the bilateral lower extremities are not met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1964 to November 1967. These issues come before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. The issues were previously before the Board in October 2019 when it was remanded for VA examinations. The Board finds that there has been substantial compliance with its prior remand directives as to the following three issues only. See Stegall v. West, 11 Vet. App. 268 (1998). Service Connection 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). 1. Entitlement to service connection for residuals of a left hip dislocation is denied. The Veteran contends that in-service motor vehicle accident (MVA) injuries caused his current residuals of a left hip dislocation. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of left hip degenerative arthritis and septic arthritis and evidence shows that in-service MVA injuries occurred, the preponderance of the probative evidence weighs against finding that the Veteran’s diagnosis of degenerative arthritis and septic arthritis began during service or is otherwise related to an in-service injury, event, or disease. VA treatment records show the Veteran was not diagnosed with bilateral hip degenerative joint disease until March 2010, more than four decades after separation from service. While the Veteran is competent to report having experienced symptoms of hip pain intermittently since service, the Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of degenerative joint disease. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377, 1377 n.4. In a February 2018 opinion and a February 2020 clarifying addendum opinion, the VA examiner opined that the Veteran’s bilateral hip degenerative joint disease is not at least as likely as not related to an in-service injury, event, or disease, including MVAs. The rationale was as follows. The veteran's service treatment records document a dislocated left hip from a MVA in service on 5/21/1967 which was reduced without need for surgical intervention. The veteran is claiming that his current left hip pain is secondary to that dislocation in service. X-rays on 3/20/2010 showed mild degenerative joint disease of BOTH hips as do more recent x-rays dated 2/17/2018. The veteran underwent a prolonged hospitalization in October 2015 following a perforated sigmoid diverticulum which led to bacteremia and fungemia, resulting in a septic left hip joint with pyogenic myositis as per MRI dated 10/9/2015. The infection was eventually controlled and successfully treated, and the veteran had no sequelae in that left hip. Given the fact that the veteran had developed BILATERAL DJD in 2010, it is less likely than not (in fact, beyond any reasonable doubt) that the left hip dislocation in 1967 had any role in his current left hip DJD or the recent septic hip joint. The mild bilateral DJD is fully compatible with the aging process in a 73-year-old male. Had the veteran developed DJD in only the left hip, credence could be given to the original trauma from the dislocation as etiologic in the genesis of the DJD, but the presence of bilateral DJD eliminates that postulate. It is not surprising that the veteran has had periodic hip pain, both left and right, over the years given the fact that he was a plasterer for his entire working career, which is an occupation that requires constant standing, reaching, bending and stretching and is certain to produce periodic hip strain and eventually DJD. The February 2020 VA examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The February 2020 VA medical opinion is more probative than the February 2018 VA medical opinion because the February 2020 VA medical opinion adequately addressed the Veteran’s lay statements, including his April 2020 testimony, and the February 2018 VA medical opinion did not. Service treatment records note hip treatment. The Veteran’s left hip was dislocated in the May 1967 MVA. Diagnostic imaging at the time, however, was “essentially normal.” The November 1967 separation Report of Medical Examination also showed a “normal” clinical evaluation. Post-service treatment records show hip treatment more than four decades after separation. In March 2010, the Veteran sought emergency care for left lower back pain that radiated to hip severe enough that it interfered with his sleep and ability to walk. Diagnostic imaging showed degenerative joint disease (DJD). In April 2010, he reported that his hip pain was better. In January 2015, the Veteran had private treatment for acute diverticulitis, during which diagnostic imaging showed “degenerative changes of the hips.” October 2015 VA diagnostic imaging showed “no significant abnormality.” In February 2018, the Veteran underwent a VA examination. The VA examiner diagnosed March 2010 degenerative arthritis left and right hip and October 2015 septic arthritis left hip. The Veteran reported his May 1967 MVA and that his hip and knees began to hurt about eight years prior to the February 2018 VA examination. The Veteran reported current periodic pain that did not impair his functioning. The Veteran reported no flareups. Diagnostic imaging showed “mild” joint space loss at the level of the hips, but no acute fracture or dislocation. The VA examiner found there was no functional impact on the ability to work. There was no right hip pain on passive ROM or non-weight bearing. At the April 2019 Board hearing, the Veteran was equivocal on the cause of his current left hip condition. The Veteran testified that he did not have any hip problems prior to service. The Veteran testified that his hip was dislocated during his May 1967 MVA and reset during treatment for his resulting injuries. The Veteran also testified that post-service construction work may have contributed to his symptoms of hip pain but denied any significant hip injuries since service. The Veteran testified that no doctor had ever said that the hip pain symptoms were due to military service. In August 2019, the Veteran’s spouse wrote that the Veteran has had hip pain since they have been married. They were married in July 1968, within one year of his separation, and they had known each other before the May 1967 MVA. In February 2020, the Veteran underwent another VA examination. The VA examination diagnosed March 2010 degenerative arthritis and October 2015 septic arthritis. The Veteran reported the May 1967 left hip dislocation and periodic left hip dislocation. The Veteran denied surgeries, flareups, and functional loss. The VA examiner found there was no functional impact on the ability to work. There was no right hip pain on passive ROM or non-weight bearing. The Veteran and the Veteran’s spouse believe the Veteran’s current left hip degenerative arthritis and septic arthritis is related to an in-service injury, event, or disease. The Veteran and the Veteran’s spouse in this case are not competent to provide a nexus opinion regarding this issue.  The issue is medically complex, as it requires knowledge of anatomical relationships, pathology, and interpretation of complicated diagnostic medical testing.  Therefore, it is outside the competence of The Veteran and the Veteran’s spouse in this case because the record does not show that they have the medical training or credentials to make such a determination.  Jandreau, 492 F.3d at 1377 n.4; see also Kahana, 24. Vet. App. at 428.  The Board finds the lay statements credible, but to the extent that they do support the Veteran’s claim, the Board gives more probative weight to the February 2020 VA medical opinion. Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the Veteran’s claim for entitlement to service connection for residuals of a left hip dislocation.  As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b). The claim is denied. 2. Entitlement to service connection for a lumbar spine condition is denied. The Veteran contends that in-service motor vehicle accident (MVA) injuries caused his current lumbar spine condition. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has current diagnoses of multilevel degenerative disc and joint disease of the lumbar spine and L5/S1 disc extrusion with spinal stenosis, and evidence shows that in-service MVA injuries occurred, the preponderance of the evidence weighs against finding that the Veteran’s diagnoses of multilevel degenerative disc and joint disease of the lumbar spine and L5/S1 disc extrusion with spinal stenosis began during service or is otherwise related to an in-service injury, event, or disease. VA treatment records show the Veteran was not diagnosed with disc degeneration and desiccation with multilevel disc bulges until March 2010, more than four decades after separation from service. While the Veteran is competent to report having experienced symptoms of back pain intermittently since service, the Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of multilevel degenerative disc and joint disease of the lumbar spine or L5/S1 disc extrusion with spinal stenosis. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Further, the February 2020 VA examiner opined that the Veteran’s multilevel degenerative disc and joint disease of the lumbar spine and L5/S1 disc extrusion with spinal stenosis is not at least as likely as not related to an in-service injury, event, or disease, including MVAs. The rationale was as follows. The veteran states that he does not remember injuring his back in service, although he does note the MVA in 1967 as a possible source of trauma. The STRs noted that he fractured his left humerus and dislocated his left hip, but there is no mention of any complaints of back pain. The STRs are totally silent for back problems as is the separation examination dated 11/20/1967. There is no documentation of back problems after service until the first x-rays on file dated 3/24/2010 (MRI) which showed multilevel degenerative joint and disc disease of the lumbar spine. Given the silent STRs, the silent separation examination, and the absence of any documentation of recurring or persistent back problems from separation until 2010 (a period of 43 years), it is less likely than not (in fact, beyond any reasonable doubt) that his current back condition is related to military service. It is more likely than not that his many decades as a ceiling plasterer resulted in repeated low back stress which led to the current condition. The February 2020 examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304. The February 2020 VA examiner appeared to have considered the record’s lay statements, including the Veteran’s April 2019 testimony about his construction work as a plasterer may have contributed to his back pain since service. A review of the Veteran’s service-treatment records does not show back treatment. The November 1967 separation Report of Medical Examination, for example, showed a “normal” clinical evaluation. In March 2010, the Veteran was treated at a VA emergency department for left lower back pain that radiated to hip for one week. He described the pain as “10/10” that prevented him from walking well and sleeping. April 2011 MRI showed disc degeneration and desiccation and a disc extrusion centrally at L5-S1 causing spinal stenosis. In August 2011, the Veteran complained to his VA primary care physician about occasional muscle tightness in back and neck. In December 2011, he sought private treatment for his lumbar back pain and a nurse practitioner prescribed medication. In October 2013, a VA plastic surgeon also noted lumbar radiculopathy. In January and April 2014, the Veteran again reported low back pain and his medications were continued. A private December 2014 abdomen and pelvic diagnostic imaging showed advanced L5-S1 degenerative disk disease. In March 2018, lumbar radiculopathy was still listed as an active problem at the VA. At the April 2019 Board hearing, the Veteran was equivocal on the cause of his current lumbar spine condition. The Veteran denied any back problems prior to service. The Veteran testified that, during an unspecified time after service, he had lower back pain when bending down, but that his work in construction may have been contributing to it. He denied lifting anything at work other than plaster mud. He further testified that he had ached “all his life” and, when prompted, clarified that it had ached since discharge. Later in the hearing, the Veteran reported that he has “always had back pain,” but when prompted he again clarified that it was since the in-service accident. He denied treatment until the preceding seven years. He said he had had pain, but he was also working so figured that he had “probably strained doing something.” He denied that any doctor had told him that his back pain related to his service. He also denied any substantial post-service back injuries. In August 2019, the Veteran’s spouse wrote that the Veteran has had back pain since they have been married. They were married in July 1968, within one year of his separation, and they had known each other before the May 1967 MVA. In February 2020, the Veteran underwent a VA examination. The VA examiner diagnosed March 2010 multilevel degenerative disc and joint disease of the lumbar spine and April 2011 L5/S1 disc extrusion with spinal stenosis. The Veteran reported his in-service MVA but stated that he “does not remember injuring his back” in-service or seeking back treatment after service until March 2010. He reported no surgeries, no flareups, and no functional impairment. The VA examiner found that the Veteran’s back condition had no functional impact on the Veteran’s ability to work. The Veteran and the Veteran’s spouse believe the Veteran’s multilevel degenerative disc and joint disease of the lumbar spine and L5/S1 disc extrusion with spinal stenosis is related to an in-service injury, event, or disease. The Veteran and the Veteran’s spouse in this case are not competent to provide a nexus opinion regarding this issue.  The issue is medically complex, as it requires knowledge of anatomical relationships, pathology, and interpretation of complicated diagnostic medical testing.  Therefore, it is outside the competence of the Veteran and the Veteran’s spouse in this case because the record does not show that they have the medical training or credentials to make such a determination.  Jandreau, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana, 24. Vet. App. at 428.  The Board finds the lay statements credible, but to the extent that they do support the Veteran’s claim, the Board gives more probative weight to the February 2020 VA medical opinion. Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the Veteran’s claim for entitlement to service connection for lumbar spine condition.  As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b). The claim is denied. 3. Entitlement to service connection for radiculopathy of the bilateral lower extremities is denied. The Veteran contends that in-service motor vehicle accident (MVA) injuries caused current radiculopathy of the bilateral lower extremities. Alternatively, the Veteran contends that current radiculopathy of the bilateral lower extremities was caused by degenerative joint disease of the lumbar spine, which the Veteran contended is service connected. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a diagnosis of left lumbar radiculopathy, the preponderance of the evidence is against finding that it began during active service, or is otherwise related to an in-service injury, event, or disease. While the Veteran is competent to report having experienced symptoms of leg pain intermittently since service, the Veteran is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of degenerative joint disease. The issue is medically complex, as it requires interpretation of complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377, 1377 n.4. A review of the Veteran’s service-treatment records does not show treatment for radiculopathy affecting his legs. The November 1967 separation Report of Medical Examination, for example, showed a “normal” clinical evaluation. Post-service treatment records show treatment for radiculopathy more than four decades after the Veteran’s separation. In March 2010, a VA emergency department physician diagnosed left lumbar radiculopathy after the Veteran reported one week of left lower back pain that radiated to hip and interfered with sleeping and walking. Lumbar radiculopathy was still listed as an active problem in May 2015, October 2016, August 2017, and March 2018. As noted in December 2015 VA treatment notes, the Veteran was treated for “discitis of the lumbar region.” At the April 2019 Board hearing, the Veteran related current leg pain to his back condition, which has not been found to be service connected. The Veteran denied any problems with pain going down his leg prior to service. The Veteran testified that he had twice experienced leg pain after service and that his VA doctors related it to his back. During one incident, he had “a couple disks back there go out. I had my leg go out one time. I was just bending down, picking a piece of paper up, and my leg went out.” In August 2019, the Veteran’s spouse wrote that the Veteran has had knee pain since they have been married. They were married in July 1968, within one year of his separation, and they had known each other before the May 1967 MVA. In February 2020, the Veteran underwent a VA examination. The VA examiner diagnosed 2009 left lumbar radiculopathy. The Veteran reported periodic left leg pain with tingling and numbness. The Veteran’s left leg had “severe” intermittent (usually dull) pain and “moderate” paresthesias or dysesthesias and numbness. He had “mild” incomplete paralysis of his left sciatic nerve. He had “5/5” muscle strength, “2+” reflexes, and “normal” sensation and gait with no atrophy. He did not use an assistive device to walk. The VA examiner found that the Veteran’s radiculopathy had no functional impact on the ability to work. In July and August 2020, the Veteran sought VA treatment for right and left leg pain. Vascular laboratory results were “negative” for deep vein thrombosis. A VA surgeon did not rule out neurological spine issues, but the record did not contain electromyography testing results. While the Veteran and the Veteran’s spouse believe that the Veteran’s left lumbar radiculopathy is related to in-service MVA injuries, the Board reiterates that the preponderance of the evidence weighs against findings that in-service lower extremity injuries occurred. Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or aggravated beyond its natural progress by, a service-connected disability. The Board concludes that, while the Veteran has a current disability, the preponderance of the probative evidence is against finding that the Veteran’s left lumbar radiculopathy is proximately due to or the result of or aggravated beyond its natural progression by a service-connected disability. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The February 2020 VA examiner opined that the Veteran’s lumbar spine condition (see above) and left lumbar radiculopathy are not at least as likely as not related to an in-service injury, event, or disease. The rationale was the Veteran’s service treatment records, including the November 1967 separation examination, were silent for any radiculopathy of the lower extremities. The VA examiner’s opinion is probative, because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Veteran and the Veteran’s spouse believes the Veteran’s left lumbar radiculopathy is related to, proximately due to, the result of, or aggravated beyond its natural progression by a service-connected disability or is otherwise related to active military service. However, the Veteran’s back condition has not been service connected. The Veteran and the Veteran’s spouse in this case are not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of anatomical relationships, pathology, and interpretation of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran and the Veteran’s spouse in this case because the record does not show that they have the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). The Board finds the lay statements credible, but to the extent that they do support the Veteran’s claim, the Board gives more probative weight to the February 2020 VA medical opinion. Therefore, for the reasons outlined above, the Board finds that the preponderance of evidence is against the Veteran’s claim for entitlement to service connection for radiculopathy of the bilateral lower extremities, to include as secondary to degenerative joint disease of the lumbar spine.  As the preponderance of the evidence weighs against the claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b). The claim is denied. REASONS FOR REMAND 1. Entitlement to service connection for a cervical spine condition is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding the issue of entitlement to service connection for a cervical spine condition. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). As a general matter, once VA undertakes to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not be provided.  Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).  The February 2020 VA examination cervical spine conditions and resulting VA medical opinion was inadequate. Specifically, the February 2020 VA opinion did not consider all the relevant evidence of record, including lay statements. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Dalton v. Nicholson, 21 Vet. App. 23 (2007). The February 2020 VA examiner found the Veteran’s neck condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. However, in explaining its rationale, the VA examination report only addressed the Veteran’s May 1967 motor vehicle accident (MVA), which was not the Veteran’s first in-service MVA. At the April 2019 Board hearing, the Veteran testified to two different MVAs. His first MVA happened about a year into his service, when he was rear-ended by a drunk driver and “everybody in the car had whiplash.” He testified that he was not treated at a hospital, given medication, and did not remember ever wearing a neck brace, but he was put on sick call for one to two weeks and was told to do exercises. An addendum VA medical opinion addressing the Veteran’s April 2019 Board hearing testimony about this in-service neck injury is warranted. 2. Entitlement to service connection for left rotator cuff tear with traumatic arthritis, bone spur on rotator cuff, and nerve impingement syndrome is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives regarding the issue of entitlement to service connection for a cervical spine condition. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). As a general matter, once VA undertakes to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not be provided.  Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The February 2020 VA examiner essentially made a credibility determination in the medical opinion that the Veteran’s reports of continuity were conflicting. The undersigned Veterans Law Judge had already found the Veteran’s April 2019 testimony truthful and credible and the Board remand order had required the VA examiner to make a medical determination addressing this underlying lay evidence, not to make another credibility determination. The VA medical opinion must be based on the Veteran’s reports of symptoms. The matters are REMANDED for the following action: 1. Obtain updated VA and/or identified pertinent private treatment records.  If any identified records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s cervical spine condition. The examiner must review the claims file, including a copy of this remand order. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion below. The examiner is asked to provide a response to the following: (a.) Is the Veteran’s cervical spine condition at least as likely as not related to service, including multiple in-service motor vehicle accidents (MVA)? Provide a rationale to support the opinion. At the April 2019 Board hearing, the Veteran testified to two MVAs. His first accident happened about a year into his service, when he was rear-ended by a drunk driver and “everybody in the car had whiplash.” He testified that he was not treated at a hospital, given medication, and did not remember ever wearing a neck brace, but he was on sick call for one to two weeks and was told to do exercises. In providing the requested opinion, consider the Veteran’s description of in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left rotator cuff tear with traumatic arthritis, bone spur on rotator cuff, and nerve impingement syndrome. Schedule the Veteran for a VA examination only if needed to answer the following questions. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: (a.) Is left rotator cuff tear with traumatic arthritis, bone spur on rotator cuff, and nerve impingement syndrome at least as likely as not related to service, including MVAs? Provide a rationale to support the opinion. At the April 2019 Board hearing, the Veteran testified to two MVAs. His first accident happened about a year into his service, when he was rear-ended by a drunk driver and “everybody in the car had whiplash.” He testified that he was not treated at a hospital, given medication, and did not remember ever wearing a neck brace, but he was on sick call for one to two weeks and was told to do exercises. (Continued on the next page)   The Veteran was found to be truthful and credible in his testimony by the undersigned Veterans Law Judge. The VA examiner’s medical opinion must be based on the Veteran’s reports of symptoms and not attempt another credibility determination. In providing the requested opinion, consider the Veteran’s description of in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board James Hekel, 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.