Citation Nr: 21011796 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 12-21 670 DATE: March 2, 2021 REMANDED Evaluation in excess of 20 percent for left shoulder supraspinatus tendinopathy is remanded. Service connection for a right hip disability, to include as secondary to service-connected disability, is remanded. Service connection for a left hip disability, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1995 to October 2002. The Board remanded the issues on appeal in January 2020. 1. Evaluation in excess of 20 percent for left shoulder supraspinatus tendinopathy is remanded. This claim must be remanded to obtain an adequate medical examination. The development conducted pursuant to the Board's January 2020 remand is inadequate and another remand is required. Stegall v. West, 11 Vet. App. 268 (1998). A December 2020 VA Shoulder and Arm examination report relates that left shoulder pain that caused functional loss was noted on examination, but does not indicate the point at which pain begins, as requested by the Board's remand. The report does not indicate whether the Veteran is able to raise his left arm above shoulder level, as also requested by the Board’s remand. Such findings are necessary for the proper adjudication of the Veteran's claim. On remand, the Veteran should be provided an opportunity to report for a VA examination. 2. Service connection for a right hip disability, to include as secondary to service-connected disability, is remanded. 3. Service connection for a left hip disability, to include as secondary to service-connected disability, is remanded. These claims must be remanded to obtain adequate medical opinions. The development conducted pursuant to the Board's January 2020 remand is inadequate and another remand is required. Stegall, supra. A medical opinion regarding direct service connection in a June 2020 VA Hip and Thigh examination report is inadequate because it provides a rationale that is based in large part on the lack of an in-service record of the claimed hip disabilities, contrary to the Board's remand instructions. In addition, on remand no VA medical opinion was obtained as to whether it is at least as likely as not (50 percent or greater probability) that any hip disability was caused by any service-connected disability or treatment for any service-connected disability. Regarding aggravation of a hip disability by a service-connected disability, the Board's January 2020 remand requested that a VA examiner provide an opinion “whether it is at least as likely as not (50 percent or greater probability) that any hip disability has been aggravated (increased in severity beyond the natural progress of the disorder) by any service-connected disability or treatment for any service-connected disability….” Remand at page 12. This standard for aggravation is incorrect. The correct standard is “any increase” in disability. An August 2020 VA Medical Opinion sets forth a negative medical opinion using this incorrect standard for aggravation. Moreover, in the August 2020 VA Medical Opinion the VA examiner refused to consider and discuss the significance of a diagnosis of bilateral hip strain and mild degenerative joint disease rendered during a July 2010 VA examination, as requested by the Board's January 2020 remand. Rather, the VA examiner stated that they were an independent examiner and could not comment on the July 2020 VA exam done by another physician. Stegall, supra. On remand, adequate VA medical opinions must be obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) by an appropriate clinician to determine the current severity of the Veteran’s service-connected left shoulder supraspinatus tendinopathy. The clinician should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the clinician must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the clinician must 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), a deficiency in the record (additional facts are required), or the clinician (does not have the knowledge or training). If pain on motion is observed, the clinician should indicate the point at which the pain begins. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the clinician should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the clinician must 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), a deficiency in the record (additional facts are required), or the clinician (does not have the knowledge or training). The examiner should also specifically indicate whether the Veteran is able to raise his left arm above shoulder level. 2. Obtain an addendum opinion from an appropriate clinician who should review the record and then address the following: (a) whether it is at least as likely as not (50 percent or greater probability) that any right or left hip disability is etiologically related to active service or any event, disease, or injury during service, including whether any hip disability began during active service; (b) whether it is at least as likely as not (50 percent or greater probability) any right or left hip disability was caused by any service-connected disability or treatment for any service-connected disability, including, but not limited to, right or left knee osteoarthritis, myotendinous of the lumbar spine, bilateral lower extremity radiculopathy, or bilateral musculoligamentous ankle strain; (c) or whether it is at least as likely as not (50 percent or greater probability) that any right or left hip disability has been aggravated (defined as any increase in disability) by any service-connected disability or treatment for any service-connected disability, including, but not limited to, right or left knee osteoarthritis, myotendinous of the lumbar spine, bilateral lower extremity radiculopathy, or bilateral musculoligamentous ankle strain. If aggravation is found, the clinician should quantify the degree of aggravation and determine the baseline disability (prior to aggravation), if possible. In addressing the above, the clinician must specifically consider and discuss the significance of the Veteran’s diagnosis of a bilateral hip strain and mild degenerative joint disease rendered during the Veteran’s July 2010 VA examination. The clinician must also consider and discuss the Veteran’s lay statements regarding the claimed hip disabilities and their etiology, specifically that they stem from repetitive parachute jumps during his service, or in the alternative are secondary to his service-connected back and joint disabilities. The clinician must also reconcile his or her opinion with any previous opinions of record. A clearly stated rationale for each opinion offered must be provided and must not be based on the lack of an in-service record of the claimed disability. 3. Confirm that the VA medical opinions provided comport with the instructions in this remand, specifically that the standard for the secondary aggravation opinions is any increase in disability (not the standard of beyond the natural progression). If not, obtain an addendum using the correct standard. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Davitian, 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.