Citation Nr: 21028066 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 15-19 394 DATE: May 10, 2021 REMANDED Entitlement to service connection for cervical radiculopathy, to include as secondary to service-connected cervical spinal fusion and/or lumbar spine disability, is remanded. Entitlement to service connection for right upper extremity (RUE) neuropathy, to include as secondary to service-connected right shoulder disability, is remanded. REASONS FOR REMAND The Veteran served in the United States Army from October 1986 to November 1991. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in October 2020, when it was remanded for further development. The Board notes that the other four issues (entitlement service connection for a cervical spinal fusion disability, a lumbar spine disability, a right shoulder disability, and a migraine headaches disability) that were previously remanded by the Board in October 2020 have been granted service connection in an April 2021 rating decision. As such, they are no longer before the Board. In the October 2020 Board remand, a VA examination and opinion was requested in order to assess the nature and etiology of the Veteran's reported cervical radiculopathy and RUE neuropathy. In the March 2021 VA examination, the examiner stated, for both conditions listed above, "there was insufficient objective evidence found to diagnose this condition." However, the Board notes that an examination for neuropathy/radiculopathy was not provided in order to assess the Veteran's reported symptoms, as instructed by the October 2020 remand directives. In addition, a February 2013 VA examination notes a diagnosis of C7 radiculopathy as well as symptoms such as moderate constant pain, mild paresthesias, and moderate numbness in the right upper extremity. As the examination report does not indicate that the examiner considered or addressed all the pertinent evidence of record and appears to base the conclusion provided on an inaccurate factual premise, the Board finds the opinion inadequate. In addition, as the Veteran has reported symptoms of pain in her cervical spine and RUE, the examiner must offer an opinion as to whether there is any objective impairment of functioning as a result of any undiagnosed RUE or cervical disability, and if so, whether that is related to service. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Therefore, the Board must remand the appeal in order to obtain an addendum opinion (and examination, if found necessary) that addresses the above deficiencies. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Obtain an addendum opinion (an examination should be scheduled only if found necessary by the medical professional asked to provide the opinion) from the March 2021 examiner or another appropriate clinician. The examiner must identify all cervical spine or right upper extremity disabilities found to be present. The examiner must consider the February 2013 VA examination that notes symptoms of right upper extremity neuropathy and a diagnosis of cervical spine radiculopathy. (a) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any disability of the right upper extremity (e.g., cervical radiculopathy or neuropathy) is related to an in-service injury, event, or disease. (b) The examiner is also asked to provide an opinion as to whether it is at least as likely as not that any disability of the right upper extremity (e.g., cervical radiculopathy or neuropathy) is caused or aggravated by the Veteran's service-connected right shoulder or cervical spine disabilities. Causation and aggravation are separate concepts and must be addressed individually. (c) With respect to the claimed right upper extremity disorders, if the Veteran does not have diagnosable pathology for her right upper extremity pain, the VA examiner must provide an opinion on whether the right upper extremity pain causes a functional impairment of earning capacity. If so, the examiner is asked to provide an opinion as to whether the right upper extremity pain that causes functional impairment of earning capacity is at least as likely as not attributable to an in-service injury, event, or disease or if it is caused or aggravated by the Veteran's service-connected right shoulder or cervical spine disabilities. The examiner must address both causation and aggravation for the opinions to be deemed adequate. The examiner should be aware that Ward v. Wilkie, 31 Vet. App. 233 (2019) held that a "permanent worsening" of a nonservice-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation may include temporary worsening of a disability). The examiner should provide a detailed and medically-supported rationale for all opinions given. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Ariasaif, 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.