Citation Nr: 21041188 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 11-08 098 DATE: July 8, 2021 REMANDED Entitlement to service connection for a right elbow disability is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Air Force from June 1975 to May 1981, and from August 1981 to August 2001. This case was most recently before the Board in November 2020, at which time it was remanded for additional development. The case has since returned to the Board for appellate consideration. Entitlement to service connection for a right elbow disability is remanded. In its November 2020 remand instructions, the Board requested an addendum opinion concerning the etiology of the Veteran's right elbow disability. The requested opinion was provided in January 2021. The examiner found that the Veteran's claimed right elbow disability was less likely than not related to service because while service treatment records (STRs) showed right elbow complaints, they were negative for a diagnosis of right lateral epicondylitis during serviceinstead, that condition was not diagnosed until 2007. Further, the examiner found that right elbow osteoarthritis was not diagnosed until 2015, which was 14 years post service; therefore, it was less likely than not related to service. Finally, the examiner determined that while a 2009 EMG showed evidence of ulnar nerve neuropathy consistent with cubital tunnel syndrome, it was less likely than not related to the numbness in ulnar distribution in the right hand and possible ulnar neuropathy noted during service. Upon review, the Board finds the rationales provided in the addendum opinion to be inadequate to decide the Veteran's claim. The probative value of a medical opinion comes primarily from its reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (noting that medical opinion evidence is not "entitled to any weight in a service-connection or rating context if it contains only data and conclusions"). See also Bloom v. West, 12 Vet. App. 185, 187 (1999) (finding that the value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion"). Here, the VA examiner did not explain why the mild osteoarthritis shown during the March 2015 x-ray was less likely than not related to service, except to note that it was diagnosed 14 years after discharge. Nor did the examiner explain why the ulnar neuropathy consistent with cubital tunnel syndrome, shown during the 2009 EMG, was less likely than not related to the numbness in ulnar distribution of the right hand and possible ulnar neuropathy noted during service. Therefore, although the Board regrets the additional delay, remand is necessary to obtain well-reasoned opinions drawing from clinical data, medical literature, and other information as necessary to adequately explain the etiology of the Veteran's right elbow disability. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion concerning the etiology of the Veteran's right elbow disability. If the January 2021 examiner is unavailable, the opinion should be rendered by another appropriate medical professional. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. After review of the evidence, to include the Veteran's STRs, VA treatment records, Tricare and private treatment records, and lay testimony, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's right elbow disability, including osteoarthritis, cubital tunnel syndrome, and ulnar neuropathy is etiologically related to his period of active service. The examiner should address STRs documenting right elbow pain and neuropathy. The examiner must provide a complete rationale for any opinion rendered by explaining the medical basis or bases on which the opinion is based, with identification of the evidence of record. If an opinion cannot be offered without resorting to mere speculation, the examiner should explain why this is the case and identify any additional evidence that may allow for a more definitive opinion. 2. Then, readjudicate the claim. If the benefit remains denied, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate time for response. Then, return the appeal to the Board, as warranted. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. T. Raftery, 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.