Citation Nr: 21007992 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 11-08 859 DATE: February 11, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1961 until August 1964. This appeal was most recently before the Board in October 2020 when it was remanded for an addendum medical opinion. Unfortunately, there has not been substantial compliance with the Board’s prior remand directives. Another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (c). 38 U.S.C. § 7107 (a)(2). Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. The claims must be remanded again because the October 2020 \medical opinions obtained subsequent to the Board’s remand are inadequate. The October 2020 opinion provider gave a negative nexus opinion for the left shoulder disability, but again improperly relied upon an absence of documentation at separation or in medical records following separation as affirmative negative evidence. Despite a specific directive in to do so, the examiner failed to consider the Veteran’s lay statements that his left shoulder disability began during service and that he experienced continued symptomatology since service. The opinion provider also failed to discuss the Veteran’s prior statements that he injured his left shoulder in a fall on a rifle range at Fort Benning, Georgia in June or July 1963, that he experienced issues with his shoulder at separation, and that he began treating his left shoulder with ibuprofen eight or less years after separation. The Veteran is competent to report the symptoms he experienced. A medical opinion that fails to consider all evidence of record, including the Veteran’s lay statements, is inadequate. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The negative opinion provided by the same examiner as to the left knee disability is inadequate for similar reasons. Again, the examiner did not specifically consider the Veteran’s competent, credible lay statements regarding continued symptomatology since service. The examiner stated that there is no evidence of any residuals since service. However, the Veteran’s prior lay statements that he experienced issues with his left knee at separation and that he began treating it with over the counter medication eight or less years after leaving active service constitute competent lay evidence that must be considered. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the October 2020 examiner, if possible, or an appropriate clinician regarding the likely etiology of the Veteran’s left shoulder and left knee disabilities. Copies of all pertinent records should be made available to the opinion provider for review. If an opinion cannot be made without examination, schedule the Veteran for an examination (or telehealth interview, etc., if appropriate). Based on a review of the record, the opinion provider must answer the following: (a.) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed left knee disability is related to an in-service injury, event, or disease, including the Veteran’s in-service fall on his left knee in June 1964? (b.) It is at least as likely as not (50 percent or greater probability) that any currently diagnosed left shoulder disability is related to an in-service injury, event, or disease, including a July 1963 fall at Fort Benning, Georgia? The examiner is notified that any provided opinion that does not specifically consider and address the Veteran’s lay assertions that the injuries occurred in service, that he continued to have problems with his left knee and left shoulder upon separation, and that he began treating with over the counter medication eight years or less after separation from service will be inadequate. A complete rationale must be provided for all opinions. If the opinion provider cannot provide an opinion without resort to speculation, the opinion provider must say why. 2. After completion of the foregoing, the agency of original jurisdiction must ensure the obtained medical opinions comport with the directives of this remand prior to readjudication of the claim. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.