Citation Nr: 21021356 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 12-30 421 DATE: April 12, 2021 REMANDED Entitlement to service connection for a bilateral shoulder disability, to include rotator cuff tears, shoulder arthrofibrosis, and arthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to April 1970. The Board notes that the Veteran died in November 2017 and his surviving spouse (Appellant) has been substituted in his place in connection with the issue of entitlement to service connection for a bilateral shoulder disability. This matter comes before the Board of Veteran’s Appeals (Board) from a September 2011 rating decision by a Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the appeal for further development in February 2015, and then remanded it again in September 2016 for lack of compliance with prior remand directives. The Board denied the appeal in August 2018 decision, and the Appellant appealed to the Court of Appeals for Veterans Claims (Court). In July 2019, the Court granted a Joint Motion for Partial Remand (JMPR), vacating the decision and remanding the appeal back to the Board. In September 2019, the Board remanded the appeal to obtain the Veteran’s complete service personnel records, any outstanding treatment records, and a new VA examination. The case has now returned to the Board for consideration. Entitlement to service connection for a bilateral shoulder disability, to include rotator cuff tears, shoulder arthrofibrosis, and arthritis. The Appellant asserts that the Veteran had bilateral shoulder disability, to include rotator cuff tears, shoulder arthrofibrosis, and arthritis. The Veteran was afforded a new VA opinion in December 2020. The clinician diagnosed the Veteran with bilateral acromioclavicular joint osteoarthritis and opined that the disability was less likely than not related to service. In support of that contention, the clinician stated that, “cold weather or crouching is not an established primary etiology of shoulder pathology[,] rather the abnormal shoulder conditions are more likely due to chronic wear and tear and age-related changes.” The clinician recognized the Veteran’s active service included being hunched over, in confined spaces, while exposed to extremely wet and cold conditions, but failed to address the Veteran’s working in such environments while extending his arms. The Board’s previous remand directives specifically requested such consideration. Additionally, after the examination, the appellant’s representative submitted medical treatises suggesting a connection between arthritis and extreme cold, a connection between arthritis and joint overuse during a soldier’s service, and a connection between arthritis and general military service. As this information was provided after the December 2020 opinion, the VA clinician did not have the opportunity to review the treatises. In consideration of the above, a remand for an addendum opinion is warranted. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s bilateral shoulder disability, to include rotator cuff tears, shoulder arthrofibrosis, and arthritis. The evidentiary record, including a copy of this remand and the medical treatises provided by the Appellant’s representative, must be made available to, and reviewed by, the clinician. The opinion should note that this record review took place. The examiner should identify all bilateral shoulder disabilities that the Veteran has had since filing his claim. The examiner should provide an opinion for each shoulder disability regarding: Is it at least as likely as not that the Veteran’s bilateral shoulder disability was incurred in, or is otherwise related, to his time on active service, to include the physical requirements of the Veteran’s MOS in which the Veteran worked (a) hunched over (b) in confined spaces (c) while exposed to extremely wet and cold conditions and (d) with his arms extended. The clinician must review and address the medical treatises provided by the Appellant in each opinion. In rendering this opinion, the clinician is advised that the Veteran was competent to report his symptoms and history where such reports exist in the evidentiary record. If the clinician rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The clinician should not improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. Marissa Caylor Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Lee Feldman, 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.