Citation Nr: 21032464 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-40 643A DATE: May 27, 2021 REMANDED Entitlement to service connection for right shoulder condition, to include as secondary to service-connected PTSD and/or Gulf War environmental hazards, is remanded. Entitlement to service connection for left knee condition, to include as secondary to service-connected PTSD and/or Gulf War environmental hazards, is remanded. Entitlement to service connection for left ankle condition, to include as secondary to service-connected PTSD and/or Gulf War environmental hazards, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1983 to March 1985 and from October 1988 to January 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this case in December 2018 for further development. 1. Entitlement to service connection for right shoulder condition, to include as secondary to service-connected PTSD and/or Gulf War environmental hazards, is remanded. 2. Entitlement to service connection for left knee condition, to include as secondary to service-connected PTSD and/or Gulf War environmental hazards, is remanded. 3. Entitlement to service connection for left ankle condition, to include as secondary to service-connected PTSD and/or Gulf War environmental hazards, is remanded. In its December 2018 decision, the Board directed the VA examiner to address whether the Veteran's right shoulder condition, left knee condition, and left ankle condition were secondary to his service-connected posttraumatic stress disorder (PTSD). In doing so, the examiner was to review and discuss the relevance of two articles: "The Prevalence of Post-Traumatic Stress Disorder in Chronic Pain Patients" and "Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiological Studies." While the April 2019 VA examiner provided a detailed discussion on the relevance of the first article, she did not discuss the second article. As such, a remand is required. See Stegall v. West, 11 Vet. App. 268, 270 (1998). Additionally, the April 2019 VA examiner opined that it was less likely than not that the Veteran's right shoulder condition was due to his military service, to include Gulf War environmental hazards, based primarily on her finding that his right shoulder condition was due to a "worker's comp injury" that occurred in 2015 or 2016. However, the Veteran was diagnosed with a right shoulder condition, specifically arthritis of the acromioclavicular joint of both shoulders, in a January 2013 VA examination indicating that the Veteran had a right shoulder condition that pre-dated his workplace injury. As such a remand is required. The matters are REMANDED for the following action: Obtain a supplemental VA opinion from an appropriately qualified examiner regarding the nature and etiology of the Veteran's right shoulder condition, left knee condition, and left ankle condition. Only if deemed necessary to provide an opinion, should the Veteran be afforded a new VA examination. Provide the claims file, including a copy of this REMAND, to the examiner for review. Following review of the claims file, the VA examiner is asked to address the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran's right shoulder condition, left knee condition, and/or left ankle condition had its clinical onset during active service or is related to any in-service disease, event, or injury, to include Gulf War environmental hazards? (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran's right shoulder condition, left knee condition, and/or left ankle condition is proximately due to or the result of the Veteran's service-connected PTSD? (c) Is it at least as likely as not (50 percent probability or greater) that the Veteran's right shoulder condition, left knee condition, and/or left ankle condition is aggravated by the Veteran's service-connected PTSD? Additionally, in support of his claim the Veteran submitted articles suggesting a link between PTSD and physical health, "The Prevalence of Post-Traumatic Stress Disorder in Chronic Pain Patients" and "Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiological Studies." See Correspondence January 2013. The examiner is to review and address the relevance of both of these articles. Such consideration should be reflected within the rationale. Further, the examiner is advised that while VA treatment records indicate that the Veteran suffered a work-related right shoulder injury in February 2016, he was diagnosed with arthritis of the acromioclavicular joint of both shoulders in a January 2013 VA examination. As such, his right shoulder condition pre-dates his workplace injury. The examination report must include a complete rationale for all opinions expressed. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Ko, 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.