Citation Nr: 21008073 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 15-14 062 DATE: February 11, 2021 REMANDED Entitlement to service connection for medial epicondylitis of the right elbow (right elbow condition), to include as secondary to service-connected right shoulder disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Marine Corps from October 1976 to October 1980, and from February 1989 to November 1997. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. This matter was previously before the Board in July 2018, where it was remanded for further development. The Board notes that there was not substantial compliance with its July 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). Regrettably, the Board finds that another remand is necessary. As noted above, in July 2018, the Board remanded the Veteran’s claim for additional development, specifically requesting that the Veteran be provided an addendum VA medical opinion that adequately addresses the nature and etiology of the claimed condition on a direct and secondary basis. In response to the Board’s remand, the RO obtained several VA medical opinions (dated December 2019, June 2020, and September 2020). However, upon review of each, the Board finds these opinions to be inadequate for adjudicative purposes, as the examiner failed to provide a rationale regarding the aggravation prong of a secondary service connection claim, as well as, improperly relied on the absence of medical evidence showing symptoms, complaints, treatments, or diagnosis of a right shoulder condition in service, without consideration or discussion of the Veteran’s assertion of the in-service physical wear and tear of the body as a possible cause of his right elbow condition. Therefore, the Board finds that the Veteran should be provided another examination and addendum VA medical opinion that adequately addresses his claim, prior to re-adjudication and in compliance with Stegall. Accordingly, a remand is necessary to address the matters discussed above. The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his right elbow condition and obtain any outstanding records and associate them with the Veteran’s claims file. 2. After associating all newly acquired records with the claims file, provide the Veteran a VA medical examination by an appropriate clinician to determine the nature and etiology of the Veteran’s right elbow condition. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all material relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. Following complete review of the record, the examiner must address the following: (a) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right elbow condition was incurred in or aggravated during service, or is otherwise etiologically related to service, to include as due to physical wear and tear of the body during active duty service. (b) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right elbow condition was caused and/or aggravated (beyond the natural progression) by his service-connected right shoulder condition? Please note: the examiner must address both causation and aggravation in providing the opinions requested above. (c) Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran’s lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. (Continued on the next page) (d) If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Hodges, 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.