Citation Nr: 21024265 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 16-59 027 DATE: April 22, 2021 REMANDED Entitlement to service connection for left shoulder disability, to include as secondary to neck disability, is remanded. Entitlement to service connection for right shoulder disability, to include as secondary to neck disability, is remanded. Entitlement to service connection for back condition is remanded. Entitlement to service connection for heart disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1972 to June 1977. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, a hearing was held before the undersigned. A transcript of the hearing is of record. The case was previously before the Board in January 2020 and January 2021 when it was remanded for further development. 1. Entitlement to service connection for left shoulder disability, to include secondary to neck disability, is remanded. 2. Entitlement to service connection for right shoulder disability, to include as secondary to neck disability, is remanded. The Board finds that the claims must be remanded for an additional opinion. The January 2020 and January 2021 Board remands instructed the RO to obtain a medical opinion that addressed the impact, if any, of trauma to the neck that the Veteran experienced in service. In a January 2021 VA opinion, the examiner noted that the Veteran had reported trauma to his jaw and neck after being hit by a heavy object, but did not discuss the impact of this incident, as requested in the remand. The VA examiner was also asked to provide an opinion as to whether the shoulder disabilities were caused or aggravated by the Veteran’s service-connected neck disability. The January 2021 VA examiner opined that the shoulder conditions were less likely than not aggravated by the neck condition, but as a rationale stated that treating clinicians did not mention the Veteran’s cervical spine conditions as an aggravating trigger and the shoulder conditions are separate conditions from the cervical spine. The rationale does not explain why the examiner believed the shoulder conditions were not aggravated by the service-connected neck disability. As the rationale for the opinions is inadequate, there was not substantial compliance with the remand order and new VA opinion is necessary. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for back condition is remanded. In the January 2021 Board remand, the Board requested an opinion as to whether the Veteran’s back disability was at least as likely as not related to an in-service injury, event, or disease in service. The Board noted that a March 2020 opinion was inadequate as the rationale relied on a lack of “objective” evidence. The January 2021 VA examiner found that the Veteran’s back condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the rationale is inadequate. The VA examiner noted that the Veteran stated he had chronic back pain since service, but stated as a rationale that the Veteran’s separation examination report and service treatment records are silent for back trauma or pain and noted that review of multiple VA orthopedic, pain management and physical medicine notes also provide no link of the back condition to the service. The VA examiner did not explain why the notes did not provide a link or discuss the Veteran’s report of back pain since service. As the rationale is inadequate, the Board finds the appeal must be remanded for a new VA opinion. 3. Entitlement to service connection for heart disability is remanded. In the January 2021 Board remand, the Board requested an opinion addressing the etiology of the Veteran’s heart disability, and specifically asked the examiner to consider and comment on the Veteran’s May 1977 surgery while he was in service. A VA opinion was obtained in January 2021. The VA examiner found that the Veteran’s heart condition was less likely than not incurred in service. The examiner stated that the only surgery they could find from 1977 was a Urology noted from February 1977 for a scrotal testicle surgery that would be unrelated to the claimed orthopedic conditions. At the Board hearing, the Veteran stated that the surgery was for a scrotum build up and a blocked artery on the right leg. He stated that he has had a number of stents put in both legs. The examiner did not address the surgery in relation to the Veteran’s heart disability. Therefore, the opinion is inadequate. The matters are REMANDED for the following action: 1. Update VA treatment records. 2. Thereafter, obtain an addendum opinion from an appropriate medical professional to determine the nature and etiology of the Veteran’s bilateral shoulder disability. After reviewing the claims file in its entirety, the examiner should address the following: (a) Is the Veteran’s bilateral shoulder disability at least as likely as not (50 percent or greater probability) caused by an in-service injury, event, or disease in service? (b) Is the Veteran’s bilateral shoulder disability at least as likely as not (50 percent or greater probability) caused by his neck disability; and (c) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral shoulder disability has been aggravated by his neck disability? The examiner should consider and comment on the impact, if any, the trauma to the neck the Veteran experienced in service had on his current bilateral should disability. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. After completing directive #1, obtain an addendum opinion from an appropriate medical professional to determine the nature and etiology of the Veteran’s back disability. After reviewing the claims folder in its entirety, the examiner should address the following: Is the Veteran’s back condition at least as likely as not (50 percent or greater probability) etiologically related to his military service? A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. If the examiner determines that additional physical examination is necessary to address these questions, such additional examination should be conducted. 3. After directive #1, obtain an addendum opinion from an appropriate medical professional to determine the nature and etiology of the Veteran’s heart disability. After reviewing the claims folder in its entirety, the examiner should address the following: Is the Veteran’s heart disability at least as likely as not (50 percent or greater probability) etiologically related to his military service? The examiner should consider and comment on the Veteran’s February 1977 high ligation of spermatic vein surgery while he was in service. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. Nathaniel Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Marenna, 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.