Citation Nr: 21013779 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 15-44 477 DATE: March 10, 2021 REMANDED Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right shoulder disability is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1970 to January 1972, and also periods of active duty for training (ACDUTRA). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing in May 2018. A transcript of the hearing has been associated with the virtual file and reviewed. This case was most recently before the Board in August 2020, at which time it was remanded for further development, as discussed below. The Board finds that the remand directives were not substantially complied with and thus another remand is warranted. Stegall v. West, 11 Vet. App. 268, 271 (1998).   1. Entitlement to service connection for a left shoulder disability is remanded. 2. Entitlement to service connection for a right shoulder disability is remanded. An August 2020 Board decision remanded the claims of service connection for a right shoulder disability and left shoulder disability and directed the Agency of Original Jurisdiction (AOJ) to obtain any outstanding VA treatment records, to include providing notice of missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence. The AOJ was also directed to obtain an addendum opinion to determine the etiology of the Veteran’s bilateral shoulder disability. The examiner was specifically directed to review and document such review of the Veteran’s records documenting periods of ACDUTRA. Additionally, the examiner was directed to consider the Board’s finding that the Veteran is competent and credible to describe shoulder cracking and pain while doing pushups during active service. Further, the Board remarked on documents showing periods of active duty training for 21 days in May 2008, as well as defense finance and account service leave and earning statements showing ACDUTRA from May 11, 2008 until May 31, 2008, and ACDUTRA from August 3, 2008 until August 23, 2008. Also, the Board noted medical records documenting right and left shoulder pain and the Veteran describing feeling a cracking in his left shoulder while doing pushups, which was recorded on August 20, 2008, during a period of ACDUTRA. The examiner was directed to specifically consider the aforementioned evidence. 08/05/2020, BVA Decision. An October 2020 VA medical opinion did not specifically document any review of the Veteran’s records documenting periods of ACDUTRA, as indicated in the Remand directives. The clinician opined that the Veteran’s bilateral shoulder disabilities are less likely than not related to his periods of active service. Specifically, the clinician noted that the Veteran was diagnosed a right shoulder condition in November 2008 and with a left shoulder condition in August 2008. The clinician found that there was no evidence to suggest that the Veteran was in active duty during this time period. 10/12/2020, C&P Exam. However, the clinician did not specifically consider documents showing periods of active duty in May 2008 and August 2008, as well as medical records documenting right and left shoulder pain during a period of ACDUTRA, as required by the August 2020 Remand directives. As such, the Board finds that the remand directives were not substantially complied with and, therefore, another remand is warranted. Stegall, 11 Vet. App. at 271. These matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records. All requests and responses for the records must be documented. If any identified records cannot be obtained, notify the Veteran of the missing records, the efforts taken, and any further efforts that will be made by VA to obtain such evidence, and allow him an opportunity to provide the missing records. Request the Veteran to submit any relevant private treatment reports or provide VA with authorization to obtain any such records. 2. After associating any treatment records with the claims file, request an addendum opinion (or schedule the Veteran for an in-person examination if deemed necessary) from an appropriate VA examiner to determine the etiology of the Veteran’s bilateral shoulder disability. The claims file is to be made available to the examiner and reviewed in conjunction with the examination. Then, the examiner is to address: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s LEFT shoulder disability was caused by a disease or injury in service? (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s RIGHT shoulder disability was caused by a disease or injury in service? If the examiner finds that one shoulder disability is related to service, but the other is not, then: (c.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s non service-connected shoulder disability was either 1) proximately due to OR 2) aggravated by any service-connected disability, to include his now service-connected shoulder disability? **The examiner MUST review and document such review of the Veteran’s records documenting periods of ACDUTRA.** See 8/27/2019, Military Personnel Record May; 8/27/2019, DFAS Payment Worksheet May, p. 1; 8/27/2019, DFAS Payment Worksheet August, p. 1. Additionally, the Board has found the Veteran competent and credible to describe shoulder cracking and pain while doing pushups. See 5/16/2018, Hearing Testimony, p. 3-4; 08/27/2019 Medical Treatment Record Gov’t Facility, at p. 3.** Please ensure that the obtained opinion considers the documents in this paragraph. If not, please request another addendum. The term “aggravated” refers to a worsening of the underlying condition beyond the natural progression of the disease, as opposed to temporary or intermittent flare-ups or symptoms that resolve with return to the baseline level of disability. If aggravation is found, please state, to the extent possible, the baseline level of disability prior to aggravation.   A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and 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), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board David Han 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.