Citation Nr: 21022114 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-32 664 DATE: April 14, 2021 REMANDED Entitlement to service connection for a cervical spine condition is remanded. Entitlement to service connection for a left shoulder condition is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1978 to May 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Board remanded the claims for VA etiology opinions. Unfortunately, the Board finds that the opinions are inadequate and that further remand therefore is required. Regarding service connection for a cervical spine condition, the Veteran’s contention is that cervical spondylosis and cervical disc disease are secondary to needing to use crutches for a lengthy period of time during service, or also due to heavy lifting during service. Accordingly, the Board’s prior September 2020 decision directed for an opinion to consider whether the cervical spine conditions are directly related to service, or are proximately due to or aggravated by the Veteran’s service-connected disabilities. In October 2020, a medical examination and etiology opinion were provided. Regarding a direct connection to service, the examiner opined, “Being on crutches would more than likely his [sic] shoulders and/or arms rather than affect his neck. Thus his being on crutches less likely than not injured his neck.” Regarding secondary service connection, for each service-connected disability the examiner wrote that “[t]here were no significant medical records linking the spondylosis and disc disease to the [respective] orthopedic condition. The Veteran stated that the neck condition occurred while in service.” The Board finds the October 2020 opinion inadequate for several reasons. First, the statement that using crutches would be more likely to affect the shoulder or arms rather than the neck does not answer the question whether any current cervical spine condition at least as likely as not is related to use of crutches in service. Second, to support the negative secondary service connection opinions, the examiner highlighted that the Veteran’s statement “that the neck condition occurred while in service,” but the examiner has not sufficiently discussed why, for purposes of direct service connection, the Veteran’s statement does not support that the neck condition originally occurred while in service. Moreover, in the negative opinions for secondary service connection, the examiner’s reasoning was simply that “there were no significant medical records linking the spondylosis and disc disease to the” service-connected disabilities. But such a medical record regarding any link between the claimed conditions and the service-connected disabilities is exactly what the VA medical examiner has been asked to provide. The Board therefore finds that the Veteran has not been provided with an adequate VA opinion in which a medical examiner applies his or her medical expertise to the facts of the case. 38 U.S.C. § 5103A(d); see Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (noting that the Board directs for medical opinions in order to address questions of medical etiology). A new medical opinion will therefore be ordered for the claim for service connection for a cervical spine condition. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Regarding service connection for a left shoulder condition, the Board’s prior decision directed for a VA opinion discussing any direct relationship to service or, as contended by the Veteran, aggravation of the left shoulder by the Veteran’s service-connected right wrist disability. A January 2021 VA opinion concluded that there was not a relationship between the right wrist and the left shoulder; however, the examiner was not asked to address whether there was any direct connection to service. “[A] remand by . . . the Board confers on the Veteran, . . . as a matter of law, the right to compliance with the remand orders.” Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board further notes that the author of the January 2020 left shoulder opinion wrote the October 2020 opinion for the neck condition, in which the clinician stated that “[b]eing on crutches [in service] would more than likely his [sic] shoulders . . . rather affect than his neck.” The Board will therefore ensure that this indication of a connection between in-service use of crutches and a left shoulder condition will be considered on remand. See, e.g., McLendon v. Nicholson, 20 Vet. App. 79, 83, 86 (2006). Accordingly, the matters are REMANDED for the following action: 1. Obtain an opinion regarding the etiology of any cervical spine condition, to include spondylosis and/or disc disease. The clinician must address all of the following: (a) Is it at least as likely as not that any cervical spine condition was incurred in service or is otherwise related to service, to include the Veteran’s lengthy period of time on crutches during service and/or heavy lifting during service. (b) Is it at least as likely as not that any cervical spine condition is proximately due to a service-connected condition? (c) Was any cervical spine condition at least as likely as not aggravated (worsened beyond the natural course) by a service-connected condition? The clinician’s opinion must provide a rationale with substantive application of his or her medical expertise to the facts of the Veteran’s case. A bare conclusion will not be adequate. 2. Obtain an opinion regarding the etiology of any left shoulder condition. The clinician must opine whether any left shoulder condition at least as likely as not was incurred in service or is otherwise etiologically related to service. The opinion should consider and discuss the statement in the October 2020 VA cervical spine opinion that “[b]eing on crutches would more than likely [affect] his shoulders . . . rather than his neck” and the fact that the Veteran was on crutches for a lengthy period of time during service. 3. After the above development and any other development deemed necessary is completed, readjudicate the Veteran’s claims. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Davis, 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.