Citation Nr: 21014997 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 15-18 291 DATE: March 16, 2021 REMANDED Entitlement to service connection for a left elbow disability, to include as secondary to service-connected left shoulder strain, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2002 to May 2002, from July 2002 to June 2003, and from September 2008 to October 2009. This case is before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office. In July 2018 and September 2019, the Board remanded the matter for further development. Now the matter is returned to the Board. The Veteran is seeking service connection for a left elbow disability and contends that it is secondary to his service-connected left shoulder strain. Unfortunately, the Board finds that another remand is required prior to adjudication of the matter. The Board notes that the Veteran underwent a VA examination for elbow and forearm conditions in February 2020, and the examiner provided a medical opinion that the Veteran’s current left elbow condition was less likely than not caused or aggravated by his service-connected left shoulder disability. The examiner reasoned that the Veteran’s left shoulder disability likely results in decreased use of the left arm and it essentially decreases the risk of the left elbow strains. The examiner also provided that “significant forces to the remainder of the left upper limb including the elbow are unlikely to be tolerated at the shoulder level” due to his left shoulder condition and symptoms. However, it is difficult for the Board to follow the examiner’s reasoning as the Veteran does have a current left elbow strain diagnosis, despite the decreased risk of the left elbow strain due to his left shoulder disability. See also August 5, 2019 Primary Care Note (the Veteran’s diagnosis of left elbow epicondylitis was noted). Thus, the Board finds that obtaining an addendum opinion with adequate rationale is necessary in order to make a fully informed decision on the matter. The Board notes that the Veteran’s representative cited an online article entitled, “Is Your Elbow Pain Caused by Your Shoulder?” (R. Kaselij, 2013), in support of the Veteran’s contention of secondary service connection for a left elbow condition. See March 2021 Written Brief Presentation. On remand, this online article should also be considered by the examiner, prior to rendering an addendum opinion. Accordingly, the matter is REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. Obtain an addendum opinion for the Veteran’s claimed left elbow disability. If the February 2020 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. If the examiner determines that a new examination is necessary, the AOJ should schedule one for the Veteran. The examiner should review the Veteran’s claims file and a copy of this REMAND order before rendering the requested addendum opinion. (a.) The examiner must opine whether the Veteran’s current left elbow condition is at least as likely as not (50 percent or greater probability) caused by or proximately due to his service-connected left shoulder disability. (b.) The examiner must opine whether the Veteran’s current left elbow condition is at least as likely as not (50 percent or greater probability) aggravated beyond its natural progression by his service-connected left shoulder disability. (c.) The examiner is asked to consider and discuss the March 2021 Written Brief Presentation, including an online article entitled Is Your Elbow Pain Caused by Your Shoulder? (R. Kaselij, 2013), available at https://exercisesforinjuries.com/is-your-elbow-pain-caused-by-your-shoulder/. (d.) The examiner should consider and discuss the following argument presented by the Veteran and his representative: “It has been found that when patients with shoulder injuries engage in rowing activities, e.g. pulling objects or pushing activities, e.g. doing pushups, the strain that would normally be on the shoulders during these activities cannot be tolerated. As compensation for this, the elbows naturally bend so that pressure from the object being pushed or pulled does not travel directly up through the arms and into the shoulder, which would be the case if a task is attacked the natural way if the task calls for application of body strength. Instead the elbows absorb this extra pressure.” (e.) The examiner is also advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, the examiner must provide an explanation. (f.) The examiner must provide a complete written rationale for any opinion offered. Also, if the examiner cannot provide an opinion, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond based on given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. 3. After completing the above actions and any other necessary development, the issue on appeal must be readjudicated. If the claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and his representative. L. ANDERSEN Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. E. Kim, 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.