Citation Nr: 21010408 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 99-17 593 DATE: February 24, 2021 REMANDED Entitlement to service connection for a bilateral shoulder disorder, to include as secondary to the service-connected cervical spine disability, is remanded. REASONS FOR REMAND The Veteran enrolled in the United States Army Reserve Officer Training Corps (ROTC) in August 1980 and attended Advanced Training Camp in June 1981. She had a period of active duty from September 1983 to March 1984, with additional periods of active duty for training (ACDUTRA), to include one from June 3, 1989 to June 17, 1989. These matters come before the Board of Veterans’ Appeals (Board) from a November 1997 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The issue on appeal was previously remanded by the Board in August 2018 in order to afford the Veteran a VA examination to assist in determining the nature and etiology of the Veteran’s bilateral shoulder disorder, to include whether it was secondary to the service-connected cervical spine disability. Pursuant to the Board’s remand, the Veteran underwent a VA shoulder and arm examination in October 2020. At that time, the examiner diagnosed the Veteran with bilateral shoulder rotator cuff tendonitis and right shoulder degenerative joint disease. The examiner then opined that the Veteran’s bilateral shoulder disorder was not proximately due to or the result of the service-connected spine disability. In support of this opinion, the examiner stated that “it would not be anticipated that cervical muscle spasms would cause or be the etiology of or aggravate bilateral shoulder tendonitis or ACJ DJD.” Therefore, the examiner indicated that the Veteran’s claim was less likely than not proximately due to or the result of or aggravated by Veteran’s service-connected disability. The Board finds the October 2020 VA medical opinion inadequate. In this regard, the examiner did not provide a sufficient rationale as to why the Veteran’s cervical spine muscle spasms would not cause or aggravate the Veteran’s bilateral shoulder symptoms associated with tendonitis or DJD. In other words, the VA examiner’s opinion was a conclusory statement, without thorough rationale or consideration of the Veteran’s lay statements in the opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007). This is especially problematic since the Veteran has reported that her bilateral shoulder pain began in service and that she developed bilateral pain “surrounding muscles between neck and shoulders.” See September 2009 VA joints examination report. In a November 2017 VA treatment record, the Veteran again complained of neck pain “that runs to the left shoulder and scapula.” The Veteran also reported pain in the right shoulder, although left shoulder pain was more severe. Recently, in Ward v. Wilkie, 31 Vet. App. 233 (2019), the Court of Appeals for Veterans Claims (the Court) held that the aggravation prong of secondary service connection requires a worsening of the claimed disorder, but not a permanent worsening of the claimed disorder. Rather, compensation under 38 U.S.C. §§ 1110 and 1131 and 38 C.F.R. § 3.310 (b) is due for any incremental increase in disability, meaning any additional impairment of earning capacity above the degree of disability existing before the increase, in a nonservice-connected disability resulting from a service-connected disability, regardless of its permanence. See also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). In sum, the Board finds that the October 2020 VA examiner’s opinion is inadequate. The examiner did not provide a sufficient rationale as to why the Veteran’s bilateral shoulder disorder was not caused or aggravated by her service-connected cervical spine disability. The examiner did not discuss or cite to any medical literature or properly address the Veteran’s lay statements regarding her neck and shoulder pain. As noted above, aggravation includes any incremental increase in disability, regardless of its permanence. Accordingly, a remand is required. The matters are REMANDED for the following actions: 1. Obtain another VA medical opinion from an appropriate VA examiner to address the etiology of the Veteran’s bilateral shoulder disorders. If deemed warranted, schedule the Veteran for VA shoulder examinations. All indicated tests and studies should be accomplished and the findings reported in detail. (a.) The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral shoulder disorder was either caused or aggravated (any incremental increase in disability or any additional impairment of earning capacity regardless of its permanence) by her service-connected cervical spine disability. **The examiner is specifically asked to address the Veteran’s statements regarding complaints of neck pain traveling to the shoulders. See e. g., September 2009 VA joints examination (Veteran has reported that her bilateral shoulder pain began in service and that she developed bilateral pain “surrounding muscles between neck and shoulders.”); see also November 20117 VA treatment record (where the Veteran complained of neck pain “that runs to the left shoulder and scapula.”). (b.) The examiner must provide a complete rationale for any opinions expressed. 2. Then, readjudicate the issue on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Casadei, 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.