Citation Nr: 21013222 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 13-07 466 DATE: March 9, 2021 REMANDED Entitlement to service connection for a left shoulder disability, characterized as status post left shoulder anterior labrum repair, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a lumbar spine disability (back disability), characterized as lumbar spondylosis with degenerative changes of the spine, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a right knee disability, characterized as medial meniscal tear with chondromalacia patella, to include as secondary to a service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1978 to May 1981, October 1982 to October 1985, with additional service in the Army National Guard, including from June 23, 1990 to July 7, 1990. Historically, on July 30, 1985, the Veteran complained of pain in the right leg directly behind the knee for 72 hours with no trauma. Physical examination demonstrated right posterior knee pain. Impression was probably tendonitis. The Veteran was seen on August 24, 1993, with complaints of low back. On April 29, 1994, the Veteran complained of pain and numbness radiating to lower back. On May 31, 1994, the Veteran complained of having problems with left shoulder and lower back for three or four months. Assessment was left trapezius muscle spasm. On August 22, 1994, the Veteran complained of left anterior shoulder pain. Physical examination demonstrated “pos impingement,” stable joint, and normal AC joint. Assessment was impingement stage II left shoulder. As such, the Veteran experienced problems with his right knee during active service, and low back and left shoulder problems within a few years of his 1990 motorcycle accident. In addition, an April 16, 2001, medical certificate notes that the Veteran had a shorter left leg and that his left side of the lumbosacral spine would be more affected. Further, a June 2011 letter from Dr. Louis A. Miranda Torres, Board Certified Orthopedic Surgeon noted that there was a possibility that the Veteran’s left shoulder injury occurred during the 1990 accident due to the fact that a labrum is not torn with everyday activities. In February 2018, the Board remanded the case for additional development. Specifically, the Board directed that any treatment records identified by the Veteran should be obtained and associated with the file and that the Veteran be scheduled for a VA examination to address whether the Veteran’s lumbar spine, left shoulder, and right knee disorders were related to his active duty service or caused by or aggravated by service-connected disability. In November 2018, the Veteran submitted an Internet article which noted that asymmetry between legs could subtly change a person’s gait, increasing risk of osteoarthritis in knees and that other researchers have suggested that short leg syndrome may increase the risk of low back pain. The Veteran underwent VA examination in April 2019 at which time the VA examiner found that the Veteran’s right knee meniscal tear was less likely than not related to service as it was diagnosed several years after service. The Veteran underwent VA examination in August 2019 at which time the VA examiner opined that none of the conditions had onset during service as the Veteran’s lumbar condition had its onset in 2001, the right knee meniscal tear had its onset in 2003, and the left shoulder disorders were seen years after service. The VA examiner noted that the evidence did not show any of these conditions during service, that there was no radiological evidence of any of these conditions during service or for years thereafter. The VA examiner noted that there was no anatomic, pathophysiologic, or biomechanical correlation among service-connected conditions and the Veteran’s actual left shoulder, lumbar, or right knee conditions. She noted that actual back spondylosis was an aging condition not related to service-connected conditions and that right knee meniscal tear and left shoulder labral tear had nothing to do with service-connected conditions. In June 2020, the VA examiner who conducted the August 2019 examinations provided additional opinions. The examiner indicated that she evaluated the 1985 note and that there was no evidence of any right knee diagnosis, radiological studies, or treatments thereafter and that as such, the right knee condition from 1985 was most likely acute and transient. The examiner noted that a right knee condition was not seen during his accident in 1990 and that there was no evidence in the record of any meniscal tears in 1990. In addition, the examiner noted that she evaluated the August 24, 1983, medical note but that there was no back diagnosis, radiological studies, or treatments thereafter; and the Veteran’s back pain was seen years after 1990 and was diagnosed to be due to a lumbar spondylosis as seen in radiological studies that were done 2001. The examiner further noted that Veteran was diagnosed as having a labral rupture in 2017, the same condition he had in the right shoulder in 1998. The examiner ultimately opined that the Veteran’s right knee meniscal tear, left shoulder labral rupture, and lumbar spondylosis were not caused by or secondary to service-connected left leg condition of tibiofibular fracture with leg discrepancy. The examiner noted that the Veteran’s right knee condition was due to internal derangement injuries causing meniscal tears. The examiner noted that the Veteran’s right knee suffered pivotal (twisting injury) causing it to develop meniscal tear and that such had nothing to do in terms of biomechanical or pathophysiological aspects of service-connected left tibiofibular fracture. The examiner noted that the Veteran’s back condition was most likely due to the normal aging process and was not pathophysiologically or biomechanically related to service-connected left leg fracture. The examiner further noted that the Veteran’s left shoulder disability (labral rupture) is not related at all in terms of anatomy, biomechanics or pathophysiology to service-connected left leg fracture. The VA examiner, however, did not specifically discuss whether the Veteran’s lumbar spine disorder was caused by or aggravated by service-connected leg length equality. In addition, the VA examiner did not specifically discuss Dr. Torres’ medical opinion. Further, the VA examiner did not provide an adequate discussion of the Veteran’s lay statements regarding the onset of continuation of left shoulder, low back, and right knee pain. As such, the Board does not find the April 2019, August 2019, or June 2020 VA opinions adequate. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from July 24, 2020, to the present. 2. Obtain addendum opinions from an appropriate clinician who has not provided an opinion previously for the following: Whether the Veteran’s left shoulder disorder is at least as likely as not related to service, including the Veteran’s lay statements of pain in service and since service. Whether the Veteran’s lumbar spine disability is at least as likely as not (i) related to service, including the Veteran’s lay statements of pain in service and since service; (ii) proximately due to service-connected right hip disability (trochanteric pain syndrome) or left leg disabilities (tibia/fibula fracture nonunion status and leg length inequality status post trauma); or (iii) at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected right hip or left leg disabilities. (Continued on the next page)   Whether the Veteran’s right knee disability is at least as likely as not (i) related to service, including the Veteran’s lay statements of pain in service and since service; (ii) proximately due to service-connected right hip disability (trochanteric pain syndrome) or left leg disabilities (tibia/fibula fracture nonunion status and leg length inequality status post trauma); or (iii) at least as likely as not aggravated, i.e., worsened beyond its natural progression, by service-connected right hip or left leg disabilities. In providing the requested opinions, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Olson, 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.