Citation Nr: 21009542 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 17-43 778 DATE: February 22, 2021 REMANDED Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left ankle disability is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from November 1984 to September 1987. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a videoconference Board hearing in April 2019; a transcript is of record. This matter was subsequently remanded by the Board in July 2019 for additional development. 1. Entitlement to service connection for a left shoulder disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a left ankle disability is remanded. These matters were remanded by the Board for examinations and opinions in its July 2019 decision. The Veteran asserts that he has left shoulder, knee, and ankle disabilities that are due to his time in service to include a parachute training accident. See 4/4/2019, Hearing Transcript. The Veteran has current diagnoses of left knee degenerative arthritis and left ankle degenerative arthritis as reported at the January 2021 examinations. For the Veteran’s left shoulder disability, the Board acknowledges that the January 2021 examiner found that he did not have a current disability. However, his medical treatment records show left shoulder tendinopathy in 2016. As such, the first element of service connection is met. His service treatment records show left shoulder pain, and that he twisted his left knee and ankle during service. The January 2021 examiner provided negative nexus opinions for the Veteran’s left knee and ankle disabilities. In support, she explained that while the Veteran sought treatment during service for mild left knee and ankle strains (acute injuries), his service treatment records were silent for further complaints. She concluded that his disabilities were not due to in-service injuries. For his left shoulder, the examiner stated he did not have a chronic diagnosis and therefore a nexus was not established. The Board finds these opinions to be insufficient. The examiner does not adequately support her conclusions as her rationale is conclusory. Additionally, the Veteran’s statements regarding injuring his left shoulder, knee, and ankle during a parachute training incident were not addressed. The Board has found the Veteran competent and credible to describe such a training accident. As such, the Board finds that additional addendums or examinations are warranted.   These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. All requests and responses for the records must be documented. If any identified records cannot be obtained, notify the Veteran of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow him an opportunity to provide the missing records. Request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. After associating any treatment records with the claims file, obtain an addendum opinion or schedule the Veteran for an appropriate examination to determine the etiology of the Veteran’s left shoulder disability if necessary. The claims file is to be made available to the examiner and reviewed. -- Identify any left shoulder disability during the period on appeal (May 2013 onward), to include tendinopathy. See 4/3/2019, Medical Treatment Record – Non-Government Facility. Then, address whether: (a.) Is it at least as likely as not (50 percent or greater probability) that his left shoulder disability is related to an in-service injury, event, or disease, to include his reported parachute training accident? See 4/4/2019, Hearing Transcript. **The examiner must opine on the Veteran’s left shoulder tendinopathy as it was diagnosed during the period on appeal.** 3. After associating any treatment records with the claims file, obtain an addendum opinion or schedule the Veteran for an appropriate examination to determine the etiology of the Veteran’s left knee and ankle disabilities if necessary. The claims file is to be made available to the examiner and reviewed. -- Then, address whether: (a.) Is it at least as likely as not (50 percent or greater probability) that his disabilities (left knee degenerative arthritis and left ankle degenerative arthritis) are related to an in-service injury, event, or disease, to include his reported parachute training accident? See 4/4/2019, Hearing Transcript. **The Board has found the Veteran competent and credible to describe his in-service parachute training accident. His assertions must be fully addressed in providing a nexus opinion.** A comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. (Continued on the next page)   If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Morales, 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.