Citation Nr: 21028769 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 12-28 120 DATE: May 12, 2021 REMANDED Entitlement to service connection for a left shoulder disability, to include as secondary to service-connected residuals of a midline episiotomy, is remanded. Entitlement to service connection for a left hip disability with left leg pain, to include as secondary to service-connected residuals of a midline episiotomy, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1974 to June 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) (hereinafter Agency of Original Jurisdiction (AOJ)). The Veteran testified at a January 2017 videoconference hearing before the undersigned. A transcript of the hearing has been associated with the record. The appeal was remanded in June 2017, April 2019, and December 2020 for further development. The appeal has now returned to the Board for further adjudication. Unfortunately, there has still not been substantial compliance with the Board's previous remand directives regarding the issues of entitlement to service connection for a left shoulder disability and a left hip disability. Although the Board regrets the additional delay, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the December 2020 Board remand, the AOJ was directed to obtain medical opinions that addressed the nature and etiology of the Veteran's left shoulder and hip disabilities. The examiner was specifically instructed to address an October 2011 private medical record reflecting that the Veteran had left shoulder pain due to carrying heavy loads during service, the Veteran's January 2017 hearing testimony that she carried equipment and laid wire during service, the Veteran's testimony during the January 2017 hearing that she injured her left shoulder and left hip jumping into a foxhole during service, and the Veteran's daughter's testimony that the Veteran's hip trouble began in the early 1980s. In a January 2021 VA opinion, the examiner indicated that it was less likely than not that the Veteran's shoulder disability was due to service since there was no evidence of a shoulder condition while in service, at separation, or proximate to service. The examiner explained that the Veteran's first notation of a shoulder condition following service was in 2004, and that it was more likely than not that the Veteran's shoulder condition originated in 2004. The examiner also indicated that the Veteran's service separation examinations were notably thorough, and that it was unlikely that a significant shoulder condition would have gone unreported. The examiner also opined that it was less likely than not that the Veteran's left shoulder disability was caused or aggravated by service-connected residuals of a midline episiotomy. The examiner indicated that the Veteran's theory was implausible and there was no possible physiologic or anatomic mechanism by which a healed episiotomy could impact the Veteran's shoulder condition. The examiner further indicated that this was unequivocal and that it was less likely than not that the Veteran's shoulder disability had been aggravated by her healed episiotomy. Given that the January 2021 examiner did not address the Veteran's testimony provided during the January 2017 Board hearing or the October 2011 medical record where she reported having to carry heavy loads in service, and given that the examiner did not provide a rationale or support for the opinion addressing whether the Veteran's left shoulder disability was caused or aggravated by her service-connected residuals of an episiotomy, a remand is required to obtain an addendum opinion. With regard to the Veteran's left hip disability, in a January 2021 VA opinion, the examiner concluded that it was less likely than not that it was related to service. The examiner indicated the October 1975 incident of left hip strain in service was acute and self-limiting, and that it was unlikely that a significant hip condition would have gone unreported on the separation examination which was thorough. The examiner also indicated that there was no evidence of care proximate to 2012, and that the diagnosis of left hip strain on the August 2012 examination was just being carried forward as a diagnosis. Instead, the examiner attributed the Veteran's left hip condition to a 2014 motor vehicle accident. While the examiner offered an opinion supported by rationale as to why the Veteran's hip disability was not caused by service-connected residuals of her episiotomy, he did not provide a rationale or explanation for his opinion that there was no evidence of aggravation of the Veteran's hip disability. Given that the examiner did not address the testimony that the Veteran and her daughter provided during service, as well as the lack of rationale provided for the opinion pertaining to aggravation, a remand is required to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain VA treatment records generated since November 2020 and associate them with the claims file. 2. Forward the Veteran's claims file to a qualified examiner for an opinion addressing the etiology of the Veteran's left shoulder disorder and left hip disorder. The examiner should answer the following questions: (a) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's diagnosed left shoulder disorder began in service, was caused by service, or is otherwise etiologically related to active duty service? (b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's diagnosed left shoulder disorder is caused by service-connected residuals of a midline episiotomy, or whether the service-connected residuals of a midline episiotomy has caused additional functional impairment of the left shoulder disability (e.g, additional loss of motion or functional impairment beyond the expected baseline, even if temporary)? (c) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's diagnosed left hip disorder began in service, was caused by service, or is otherwise etiologically related to active duty service? (d) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran's diagnosed left hip disorder is caused or whether the service-connected residuals of a midline episiotomy has caused additional functional impairment of the left hip disability (e.g, additional loss of motion or functional impairment beyond the expected baseline, even if temporary)? In rendering this opinion, the examiner must address the following: Service treatment records reflecting treatment for left hip pain (see, e.g., October 1975 Service Treatment Records); October 2011 private medical records reflecting left shoulder pain due to carrying heavy loads during service; and The Veteran's January 2017 hearing testimony that she carried equipment and laid wire during service, that she injured her shoulder and hip after having to jump into a foxhole during service, and her daughter's testimony that the Veteran's hip trouble began in the early 1980s. The examiner should note that the Veteran is competent to attest to factual matters of which she has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner must provide a complete rationale for any opinions provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. In rendering this opinion, if the examiner finds any gap in time between the Veteran's military service and the onset of the disorder to be probative, he or she should provide an explanation of its medical significance. 3. The AOJ should review the medical opinions to ensure compliance with this remand. If the reports are deficient in any manner, the AOJ should implement corrective procedures. 4. The AOJ should conduct any other development that may be indicated as a consequence of the actions taken in the preceding paragraphs. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Saikh, 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.