Citation Nr: 21029201 Decision Date: 05/12/21 Archive Date: 05/12/21 DOCKET NO. 15-27 112 DATE: May 12, 2021 REMANDED Service connection for a left arm condition, shoulder to elbow is remanded. Service connection for a left arm condition, elbow to wrist is remanded. Service connection for a right arm condition, shoulder to elbow is remanded. Service connection for a right arm condition, elbow to wrist is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1975 to July 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. This matter was previously before the Board in April 2019. At that time, the claims for service connection for bilateral upper and lower arm conditions were remanded to, among other things, obtain an adequate VA examination addressing the functional impairment claimed by the Veteran and whether the claimed conditions presented distinct signs and symptoms from those attributable to the Veteran's service-connected bilateral wrist and elbow disabilities. Unfortunately, the Board finds the post-remand VA medical opinions addressing the Veteran's claimed arm conditions inadequate, requiring further remand. The Board notes that the Veteran's claim for right-side cervical radiculitis was also remanded as part of the April 2019 Board decision. The record reflects that the RO granted service connection for radiculopathy of the right upper extremity in a July 2020 rating decision. As this is considered a full grant of benefits, that claim is no longer on appeal. Following the April 2019 Board remand, the Veteran was afforded a VA examination for his arm and shoulder conditions in December 2019. The VA examiner noted a diagnosis of bilateral acromioclavicular joint osteoarthritis and status post arthroscopic lysis of adhesions and capsular release with extensor debridement of the left shoulder. The VA examiner opined that the claimed bilateral upper and lower arm conditions were less likely than not incurred in or caused by service but failed to offer a rationale for the bare conclusion that "[a] nexus has not been established." Moreover, the VA examiner referenced the Veteran's service-connected elbow and wrist conditions, but failed to offer an opinion as to whether the claimed bilateral upper and lower arm conditions presented distinct signs and symptoms from those conditions. Finally, the VA examiner also failed to address the Veteran's contentions of functional impairment caused by his duties as a dental hygienist in service. Based on the foregoing, the claims for service connection for bilateral upper and lower arm conditions are remanded to obtain a clarifying VA medical opinion. As the outcome of the service connection claims may impact the Veteran's request for a TDIU, that claim is also remanded. The matters are REMANDED for the following action: 1. Obtain pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Following completion of the development in item 1, return the claims file to the examiner who conducted the December 2019 VA examination for the Veteran's arm and shoulder conditions, if available. If that examiner is not available, send the claims file to an appropriate clinician. The claims file and this remand should be made available to the examiner and review of the file should be noted in the requested report. After reviewing the claims file the examiner should respond to the following: (a.) Whether the Veteran's upper and lower arm complaints are distinct from signs and symptoms attributable to the service-connected right wrist strain, right and left elbow epicondylitis and left wrist tendonitis conditions. Please explain why or why not. (b.) Is it at least as likely as not (50 percent probability or more) that the Veteran has functional impairment of his bilateral arms, upper and lower portions, that are related to or had their onset in service? Please explain why or why not. The examiner is advised that the Veteran is competent to report symptoms and that his reports must be considered and discussed in formulating the requested opinions. If the reports are discounted, the examiner should provide a reason for doing so. A complete rationale for the examiner's opinions should be provided, citing to specific evidence of record and relevant medical literature, as necessary. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. Additionally, the examiner 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 examiner. If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required) the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide and opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Snyder, 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.