Citation Nr: 21008891 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 09-31 223 DATE: February 18, 2021 REMANDED 1. Entitlement to service connection for a left shoulder condition, to include as secondary to service-connected lumbosacral strain is remanded. 2. Entitlement to service connection for left knee condition, to include as secondary to service-connected lumbosacral strain is remanded. 3. Entitlement to service connection for a left arm condition (left elbow strain/left upper extremity ulnar neuropathy), to include secondary to service-connected lumbosacral strain is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1974 to March 1977 in the United States Army, to include active duty service in the Vietnam Era. The Board remanded the claims for further development in October 2016. There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a left shoulder condition, to include as secondary to service-connected lumbosacral strain is remanded. 2. Entitlement to service connection for left knee condition, to include as secondary to service-connected lumbosacral strain is remanded. 3. Entitlement to service connection for a left arm condition (left elbow strain/left upper extremity ulnar neuropathy), to include secondary to service-connected lumbosacral strain is remanded. The claims must be remanded again because the medical opinions obtained to date are inadequate. The March 2019 VA examination and associated medical opinions are inadequate. With respect to the left knee and left shoulder claims, the opinions do not appear to address the noted in-service injury or the Veteran’s competent testimony regarding continuity of symptoms. Further, the left shoulder opinion does not cite the referenced medical literature. With respect to the left arm claim, the examiner improperly relied mainly on the lack of documentation during the Veteran’s separation examination but did not address the Veteran’s testimony regarding continuity of symptoms. Furthermore, there was no examination done to identify any left arm ulnar neuropathy. Finally, the Veteran’s representative has raised the contention that the Veteran’s conditions may be caused or aggravated by his service-connected lumbosacral strain and no opinion on this issue has been provided to date. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician on the likely etiology of the Veteran’s left shoulder arthritis and/or superior labral anterior-posterior lesion (SLAP). Copies of all pertinent records must be made available to the examiner for review. Based on a review of the record, the examiner must answer the following questions. (a) Is it at least as likely as that the left shoulder disability is related to the Veteran’s in-service shoulder injury? (b) Is it at least as likely as not that the left shoulder arthritis and/or SLAP is (i) proximately due/caused by the service-connected back disability or (ii) aggravated by the service-connected back disability? Aggravation here is defined as any increase in disability. 2. Obtain an addendum opinion from an appropriate clinician regarding the likely etiology of the Veteran’s left knee arthritis. Copies of all pertinent records must be made available to the examiner for review. Based on a review of the record, the examiner must answer the following questions. (a) Is it at least as likely as not that the left knee disability is related to the documented in-service injury? (b) Is it at least as likely as not that the left knee disability is (i) proximately due/caused by the service-connected back disability or (ii) aggravated by the service-connected back disability? The examiner is informed that aggravation is defined as any increase in disability. 3. Obtain an addendum opinion from an appropriate clinician on the (i) likely etiology of the chronic left elbow strain and (ii) the nature and likely etiology of any left upper extremity ulnar neuropathy. The examiner must review the claims file. Copies of all pertinent records must be made available to the examiner for review. Based on a review of the record, the examiner must answer the following questions. (a) Is it at least as likely as not that the left elbow disability is related to the Veteran’s in-service shoulder injury? (b) Is it at least as likely as not that the left elbow disability is (i) proximately due/caused by the service-connected back disability or (ii) aggravated by the service-connected back disability? The examiner is informed that aggravation is defined as any increase in disability. (c) Is there a diagnosis of left ulnar neuropathy? (d) 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. (e) Is it at least as likely as not that any left upper extremity ulnar neuropathy/or functional impairment related to service, including the Veteran’s in-service left shoulder injury? (f) Is it at least as likely as not that any left upper extremity ulnar neuropathy/or functional impairment (i) proximately due to the Veteran’s service-connected back disability or (ii) aggravated by the service-connected back disability? The examiner is informed that aggravation is defined as any increase in disability. Provide a rationale to support the opinions. 5. Confirm that the VA medical opinions provided comport with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P.S. McLeod 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.