Citation Nr: 21012999 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 09-48 344 DATE: March 8, 2021 REMANDED Entitlement to service connection for right shoulder disability is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS AND BASES FOR REMAND The Veteran served on active duty in the United States Army from May 1976 to May 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2007 rating decision issued by the Department of Veteran Affairs (VA) Regional Office (RO). In December 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. 1. Entitlement to service connection for right shoulder disability. In a July 2018 decision, the Board denied entitlement to service connection for a right shoulder disability, because the evidence was against a finding that the Veteran’s right shoulder disability was due to his active duty service or secondary to his service-connected left shoulder disability. The Veteran timely filed an appeal to CAVC and argued that the January 2018 VA examination did not adequately consider all theories of entitlement including his statement that he used his right shoulder more due to the limitation of his service-connected left shoulder. The Veteran also stated that the VA examination provided a medical opinion based on an inaccurate premise. CAVC found that the VA examinations of record collectively addressed all theories of entitlement to service connection and provided rationales in support the opinion. However, the medical opinions were inadequate because the physicians based their opinion on an inaccurate factual premise. More specifically, the January 2018 examiner opined that there has been no mention [in] his records of any such causal relationship between the right and left shoulders. However, Dr. Crockett's November 2010 and December 2015 letters did allude to a relationship between appellant's service-connected left shoulder disability and his right shoulder disability. In addition, the VA physician also remarked that the Veteran’s right shoulder was repaired in 2011 and "[t]here has been no active and ongoing treatment or evaluation of [right] shoulder condition since." However, March 2012 and June 2012 treatment records reflect that the Veteran underwent occupational therapy on his right shoulder several times following his 2011 rotator cuff repair procedure. Further, treatment records from 2013 to 2017 document the Veteran's complaints of ongoing pain and limitation of motion in both the right and left shoulders. Considering this evidence, CAVC found that the VA physician's reports contained several inaccuracies. Therefore, remand is required to provide the Veteran an adequate VA examination. 2. Entitlement to service connection for erectile dysfunction. In a July 2018 decision, the Board denied entitlement to service connection for erectile dysfunction, because the preponderance of the evidence was against the claim for service connection for erectile dysfunction. The Veteran timely filed an appeal to CAVC and argued that the December 2016 VA examination stated the Veteran’s erectile dysfunction was multifactorial in etiology, but diabetes may have been a major factor. The examiner did not provide an opinion on whether the Veteran’s erective dysfunction was related to any of his service-connected disabilities. In addition, the examiner did not comply with specific remand instructions written in the February 2016 Board remand. The VA conceded with the Veteran’s argument and CAVC concurred. The December 2016 opinion is inadequate primarily because: (1) it does not rule out the possibility that the Veteran’s erectile dysfunction was aggravated to some degree by his service-connected disabilities; and (2) it lacked a rationale for the VA physician's opinion that that the Veteran’s erectile dysfunction was less likely than not caused or aggravated by his hypertension or back disability. Therefore, remand is warranted for the VA to obtain an adequate opinion as to whether the Veteran’s erectile dysfunction was secondary to his service-connected disabilities. The matters are REMANDED for the following action: 1. Obtain any outstanding medical treatment records related to the claim on appeal and associate them with the claims file, if any. 2. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of his right shoulder disability. A complete copy of the claims file, including a copy of this remand, must be provided to the examiner for review. The examiner is asked to review the claims file and indicate in the record that he or she has done so. The examiner is asked to acknowledge the findings of the previous VA examinations and private medical opinions listed in the claims file as well as the Veteran’s statements concerning his right shoulder being overused due to the limitation of his left shoulder. Only after doing the aforementioned, the examiner is asked to render an opinion: whether the Veteran’s right shoulder disability is related to his military service and/or secondary to (caused or aggravated by) his service-connected disabilities. The examiner must specifically address whether the right shoulder disability is caused or aggravated by abnormal wear and tear caused by his service-connected left shoulder injury. If an opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include 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. 3. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of his erectile dysfunction. A complete copy of the claims file, including a copy of this remand, must be provided to the examiner for review. The examiner is asked to review the claims file and indicate in the record that he or she has done so. The examiner is asked to render an opinion: Whether the Veteran’s erectile dysfunction is secondary to any of his service-connected disabilities (such as his spine disorder, psychiatric disorder, heart disease or hypertension), to include any medications taken for treatment of such disabilities. (Continued on the next page)   If an opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include 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. 4. Thereafter, readjudicate the claim on appeal MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Harris, Attorney Advisor 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.