Citation Nr: 21013194 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 14-06 883A DATE: March 8, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the Air Force from May 2004 to August 2004. She had Reserve duty from May 1979 to May 1985 (Army) and from May 1985 to May 2008 (Air Force), with periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). A hearing was conducted by video conference in April 2018 before the undersigned Veteran’s Law Judge, at which the Veteran testified; a transcript is of record. The Board previously remanded this case for additional development in July 2018. The matter has now returned to the Board for appellate review. Specifically, in its July 2018 remand, the Board directed the Agency of Original Jurisdiction (AOJ) to determine whether the Veteran’s claimed knee, feet, and shoulder disabilities were due to an injury incurred during a period of INADUTRA, ACDUTRA, or active duty. Service connection may be granted for disability resulting from disease or injury incurred during ACDUTRA or injuries incurred during INACDUTRA. See 38 U.S.C. §§ 101 (24), 106 (2012); 38 C.F.R. § 3.6 (2018). Service connection is not legally merited when the disability results from a disease process during INACDUTRA. See, e.g., Brooks v. Brown, 5 Vet. App. 484, 487 (1993). ACDUTRA is full time duty for training purposes performed by Reservists and members of the National Guard pursuant to 38 U.S.C. §§ 316, 502, 503, 504, or 505. 38 U.S.C. § 101 (22); 38 C.F.R. § 3.6 (c). INACDUTRA includes duty, other than full-time duty, performed for training purposes by Reservists and members of the National Guard pursuant to 32 U.S.C. §§ 316, 502, 503, 504, or 505; 38 U.S.C. § 101 (23); 38 C.F.R. § 3.6 (d). Pursuant to the Board’s July 2018 remand, the Veteran was afforded VA examinations in July 2019 and November 2020. At the time of both VA examinations, the same VA examiner found that the Veteran’s claimed knee and feet disorders were at least as likely as not related to injury incurred in a period of ACDUTRA, INACDUTRA, and active duty, and that the Veteran’s claimed shoulder disorder was at least as likely as not related to injury incurred in a period of ACDUTRA or INACDUTRA. However, the examiner’s opinion does not identify any specific injury during a particular period of service, upon which the Veteran can assert service connection. Moreover, contradictory findings seem to be made holding that the pathology is less likely than not related to training. As noted above, the regulations pertaining to injuries incurred in or caused by periods of ACDUTRA and INACDUTRA differ significantly from those incurred in or caused by active duty. Accordingly, the Board finds that the VA opinions of record are inadequate for purposes of determining service connection because they provide an inadequate rationale. Specifically, the examiner must identify what injury is attributable to each of the claimed disabilities, and what the nature of the Veteran’s service is for the alleged injury and/or disease; namely, whether the service at the time of the injury or disease is characterized as ACDUTRA, INACDUTRA, or active duty. Further, the examiner should determine if any of the Veteran’s disabilities pre-existed the Veteran’s periods of ACDUTRA or INACDUTRA, and if they were aggravated by the Veteran’s periods of ACDUTRA or INACDUTRA. Given this deficiency, an addendum opinion is required with respect to the Veteran’s service connection claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board’s duty to return an inadequate examination report “if further evidence or clarification of the evidence... is essential for a proper appellate decision”). The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether any currently diagnosed left shoulder, left knee, right knee, left foot, and right foot disability were incurred in or caused by the Veteran’s periods of ACDUTRA or period of active duty service. Specifically, the examiner should consider the Veteran’s statements that she fell from an airplane in July 1998 and that she participated in physical training exercises over the course of her career, and provide opinions that respond to the following: a. Identify the likely etiology of the left shoulder, left knee, right knee, left foot, and right foot disabilities. Specifically, is it at least as likely as not (a 50 percent or greater probability) that any such disability began in or was aggravated by a verified period of ACDUTRA/INACDUTRA? b. Alternatively, is there evidence in the record that renders it undebatable from a medical standpoint that a diagnosed left shoulder, left knee, right knee, left foot, or right foot disability existed on entry on active duty from May 2004 to August 2004? If so, identify the evidence. c. If a diagnosed left shoulder, left knee, right knee, left foot, or right foot disability is shown by clear and unmistakable to have pre-existed the Veteran’s service, is there further evidence in the record that renders it undebatable from a medical standpoint that the disability was not aggravated by active duty service (i.e., did not increase in severity during service or any increase in service was due to natural progression); if so identify such evidence. In particular, the examiner should consider the Veteran’s descriptions of how physical training affected her claimed disabilities. d. Regarding any left shoulder, left knee, right knee, left foot, or right foot disability that was first manifested after active duty service, is it at least as likely as not (a 50 percent or greater probability) that it is etiologically related to the Veteran’s active service? e. If a diagnosed left shoulder, left knee, right knee, left foot, or right foot disability is determined to be unrelated to service, identify the etiology for the disability considered more likely (and explain why that is so).   It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Scanlan, 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.