Citation Nr: 21041208 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 18-11 473 DATE: July 8, 2021 ORDER New and material having been received, the claim for entitlement to service connection for compression fracture of L1 is reopened; to this extent only, the claim is granted. New and material having been received, the claim for entitlement to service connection for cervical segmental dysfunction, neck pain, and myofascitis and arthritis is reopened; to this extent only, the claim is granted. New and material having been received, the claim for entitlement to service connection for bilateral pes planus is reopened; to this extent only, the claim is granted. New and material having been received, the claim for entitlement to service connection for left shoulder osteoarthritis is reopened; to this extent only, the claim is granted. Entitlement to service connection for compression fracture of L1 is denied. Entitlement to service connection for right shoulder osteoarthritis is denied. REMANDED Entitlement to service connection for cervical segmental dysfunction, neck pain, and myofascitis and arthritis is remanded. Entitlement to service connection for bilateral pes planus is remanded. Entitlement to service connection for left shoulder osteoarthritis is remanded. Entitlement to service connection for residuals of a traumatic brain injury (TBI) is remanded. Entitlement to service connection an acquired psychiatric disorder, to include major depressive disorder (MDD), is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. The claim for entitlement to service connection for compression fracture of L1 was originally denied in an unappealed May 2009 rating decision. 2. Evidence received since the May 2009 denial relates to unestablished facts necessary to substantiate the claim for service connection. 3. The claim for entitlement to service connection for cervical segmental dysfunction, neck pain, and myofascitis and arthritis was originally denied in an unappealed October 2010 rating decision. 4. Evidence received since the October 2010 denial relates to unestablished facts necessary to substantiate the claim for service connection. 5. The claim for entitlement to service connection for bilateral pes planus was originally denied in an unappealed May 2004 rating decision. 6. Evidence received since the May 2004 denial relates to unestablished facts necessary to substantiate the claim for service connection. 7. The claim for entitlement to service connection for left shoulder osteoarthritis was originally denied in an unappealed May 2004 rating decision. 8. Evidence received since the May 2004 denial relates to unestablished facts necessary to substantiate the claim for service connection. 9. The preponderance of the evidence indicates that the Veteran's claimed back condition did not arise during or as a result of his active service, and the Veteran's in-service injury was acute in nature and resolved without residuals. 10. The preponderance of the evidence is against finding that the Veteran's right shoulder osteoarthritis began during or as a result of his active service. CONCLUSIONS OF LAW 1. New and material having been received, the claim for entitlement to service connection for compression fracture of L1 is reopened; to this extent only, the claim is granted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. New and material having been received, the claim for entitlement to service connection for cervical segmental dysfunction, neck pain, and myofascitis and arthritis is reopened; to this extent only, the claim is granted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. New and material having been received, the claim for entitlement to service connection for bilateral pes planus is reopened; to this extent only, the claim is granted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 4. New and material having been received, the claim for entitlement to service connection for left shoulder osteoarthritis is reopened; to this extent only, the claim is granted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 5. The criteria for entitlement to service connection for compression fracture of L1 have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for right shoulder osteoarthritis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from January 1976 to January 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision of a VA Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at an April 2021 hearing before the Board of Veterans' Appeals (Board). The Board notes that the claims for service connection for a right shoulder injury, MDD, PTSD, and residuals of TBI were first denied in a June 2015 rating decision. These claims were denied again in a September 2015 rating decision, with the claim for PTSD being denied for lack of new and material evidence. The Veteran filed a Notice of Disagreement (NOD) in February 2016 for all the relevant issues. As this NOD was received within one year of the June 2015 and September 2015 rating decisions, the Board finds that all four of the claims discussed in this paragraph have been continuously on appeal since the date of receipt of their initial claim. Accordingly, there is no need to consider whether these claims, including the claim for PTSD, need to be reopened. Finally, the Board is expanding the Veteran's claim for service connection for MDD to include any acquired psychiatric disorder. The Veteran asserts that he suffers from MDD and PTSD as a result of his active service. Pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Board has recharacterized the Veteran's claims to include any psychiatric disorder. As emphasized in Clemons, though a Veteran may only seek service connection for one psychiatric disorder, the Veteran's claim cannot be limited only to that diagnosis but must rather be considered a claim for any mental disability that may be reasonably encompassed. New and Material Evidence Generally, a claim which has been denied may not thereafter be reopened and allowed based on the same record. 38 U.S.C. §§ 7104, 7105. However, pursuant to 38 U.S.C. § 5108, if new and material evidence is presented or secured with respect to a claim which has been disallowed, the VA Secretary shall reopen the claim and review the former disposition of the claim. New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. Id. In determining whether evidence is "new and material," the credibility of the new evidence must be presumed. Fortuck v. Principi, 17 Vet. App. 173, 179-80 (2003); Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Board must independently consider the question of whether new and material evidence has been received because it goes to the Board's jurisdiction to reach the underlying claims and adjudicate the claims de novo. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380, 1384 (Fed. Cir. 1996). If the Board determines that the evidence submitted is both new and material, it must reopen the case and evaluate the claim considering all the evidence. Justus, 3 Vet. App. at 512. Such evidence is presumed to be credible for the purpose of determining whether the case should be reopened; once the case is reopened, the presumption as to the credibility no longer applies. Id. at 513. 1. New and material having been received, the claim for entitlement to service connection for compression fracture of L1 is reopened; to this extent only, the claim is granted. In a May 2009 rating decision, the RO denied the Veteran's claim for a back disability. This decision was not appealed within 12 months and became final. Evidence received since that denial includes sworn testimony on the issue in an April 2021 Board hearing as well as new medical evidence. As this evidence is new and material, the claim for service connection for a back disability is reopened. 2. New and material having been received, the claim for entitlement to service connection for cervical segmental dysfunction, neck pain, and myofascitis and arthritis is reopened; to this extent only, the claim is granted. In an October 2010 rating decision, the RO denied the Veteran's claim for a neck disability. This decision was not appealed within 12 months and became final. Evidence received since that denial includes sworn testimony on the issue in an April 2021 Board hearing as well as new medical evidence. As this evidence is new and material, the claim for service connection for a neck disability is reopened. 3. New and material having been received, the claim for entitlement to service connection for bilateral pes planus is reopened; to this extent only, the claim is granted. In a May 2004 rating decision, the RO denied the Veteran's claim for bilateral pes planus. This decision was not appealed within 12 months and became final. Evidence received since that denial includes sworn testimony on the issue in an April 2021 Board hearing as well as new medical evidence. As this evidence is new and material, the claim for service connection for bilateral pes planus is reopened. 4. New and material having been received, the claim for entitlement to service connection for left shoulder osteoarthritis is reopened; to this extent only, the claim is granted. In a May 2004 rating decision, the RO denied the Veteran's claim for a left shoulder disability. This decision was not appealed within 12 months and became final. Evidence received since that denial includes sworn testimony on the issue in an April 2021 Board hearing as well as new medical evidence. As this evidence is new and material, the claim for service connection for a left shoulder disability is reopened. Service Connection Service connection may generally be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 C.F.R. § 3.303. To establish service connection for a disability, there must be competent evidence of: (1) a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1, 8 (1999). 5. Entitlement to service connection for compression fracture of L1 The Veteran asserts that his back disability arose during or as a result of his active service. The Veteran's service treatment records (STRs) reflect treatment for back and neck soreness, with decreased range of motion, after rappelling down a cliff in March 1979. He given Tylenol to treat his pain. Notably, his November 1975 entrance medical examination and Report of Medical History and his November 1979 pre-discharge medical examination and Report of Medical History are negative for evidence of back injuries or conditions. In January 2009, the Veteran filed an initial claim for service connection for a back condition. VA treatment records reflect lower back pain being diagnosed in May 2010. There is no evidence of treatment for back pain or back conditions prior to that date. In a June 2010 statement in support of his claim, the Veteran asserted that he injured his back during service and experienced residuals post service. In a June 2014 medical opinion by the Veteran's chiropractor, the chiropractor stated that the Veteran experienced chronic neck and back pain. They state that while they had not been able to review all of the Veteran's treatment records, they felt that the conditions were aggravated by active service or secondary to a service-connected disability. In a July 2014 Disability Benefits Questionnaire (DBQ), the Veteran's chiropractor noted chronic lower back pain due to lumbar segmental dysfunction. Social Security Administration (SSA) records, received in May 2015, reflect treatment for a back condition but are negative for evidence that condition arose during or as a result of active service. During his August 2015 VA examination for back conditions, the VA examiner noted the Veteran was positive for post-fracture of L1 with no residuals. The examiner opined that he did not have a current back diagnosis that was at least as likely as not incurred in or caused by the back-muscle strain, spasm treated in service. The examiner stated that the evidence indicated that such a condition was acute and did not have chronic residuals. In a January 2018 Form 9 statement, the Veteran asserted that his shoulder, back, and neck injuries stemmed from his in-service rappelling accident in March 1979. During the Veteran's April 2021 Board hearing, the Veteran testified that he injured his back during service when he was rappelling and fell. He reported chronic pain in his neck and back. He also stated that his chiropractor stated that the location of his pain was consistent with other Veterans they had treated and was likely due to weight-bearing and other physical activity during service. The Veteran has consistently asserted that his current lower back pain arose during or as a result of active service. In considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to etiology, diagnosis, or the onset date of a medical disability. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). His lay contentions are thus of markedly lower probative value than, and are outweighed by, the VA examination opinion and medical evidence of record. The Board finds the preponderance of the evidence is against the Veteran's claim. While his STRs reflect treatment for a back injury in March 1979, the injury appears to have been acute and not severe. Additionally, his pre-discharge medical examination and Report of Medical History are negative for back conditions. The Veteran's VA treatment records do not reflect treatment for back pain until 2010, approximately 30 years after separation from active service. While the Veteran did submit a positive medical opinion from a private chiropractor, the Board only lends that opinion some probative weight. The chiropractor acknowledged that they had not reviewed all of the Veteran's treatment records, and they found that his back pain was aggravated by service or a service-connected condition. The evidence of record does not suggest a preexisting back condition, and the Veteran was only service connected for hearing loss and tinnitus at the time of the opinion, neither of which have been specifically linked to the back disorder. Conversely, the August 2015 VA examiner found that the Veteran's in-service injury was most likely acute, with no residuals, and he did not have a current back diagnosis that was at least as likely as not incurred in or caused by the back-muscle strain and spasm treated in service. Based on these facts, the Board concludes that the preponderance of the evidence is against finding that the Veteran's claimed condition began during or as a result of active service. Accordingly, the claim for service connection for a back condition is denied. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claim, that doctrine is not applicable in this appeal. 38 U.S.C. § 5107(b). 6. Entitlement to service connection for right shoulder osteoarthritis The Veteran asserts that his right shoulder disability arose during or as a result of his active service. The Veteran's STRs reflect treatment for a right shoulder injury in September 1976. Guarding, decreased range of motion, pain on palpation, loss of strength, swelling, and deformity were noted. The Veteran's November 1979 Report of Medical History was positive for broken bones and swollen or painful joints, but neither that report nor the November 1979 medical examination report noted any shoulder conditions. In an April 2005 statement in support of his claim, the Veteran asserted that he injured his left shoulder in March 1979, during a sports game, when an opposing player ran over him. In an April 2005 Decision Review Officer (DRO) conference, the Veteran asserted that he had experienced two injuries to his left shoulder during service and chronic pain in the left shoulder since service. He stated that in-service treatment records concerning his right shoulder were in error, as his left shoulder was the shoulder that was injured. SSA records, received in May 2015, reflect treatment for a shoulder condition but are negative for evidence that condition arose during or as a result of active service. During the Veteran's August 2015 VA examination for shoulder and arm conditions, the examiner noted that x-rays demonstrated advanced osteoarthritis of the acromioclavicular joints. The examiner opined that the Veteran's current right shoulder condition was less likely than not related to service. Their rationale was based on the in-service right shoulder injury being acute only, the lack of evidence of chronicity of care, and the fact that there was insufficient evidence tying the current right shoulder complaints to his active service. In a January 2018 Form 9 statement, the Veteran asserted that an in-service rappelling accident caused left and right shoulder injuries, and he had experienced chronic pain since those injuries. The Veteran's VA treatment records are negative for complaints or treatment for shoulder conditions in the 12-month period following separation from active service or for medical opinions supporting a link between service and the current claimed condition. During his April 2021 Board hearing, the Veteran asserted that he injured his shoulder during a rappelling accident in service, when he used his right shoulder to help break his fall. In considering the Veteran's contentions, the Board notes that he is competent to observe lay symptoms but does not have the training or credentials to provide a competent opinion as to etiology, diagnosis, or the onset date of a medical disability. See Jandreau v. Nicholson, 492 F.3d at 1377. His lay contentions are thus of markedly lower probative value than, and are outweighed by, the August 2015 VA examination opinion and medical evidence of record. The Board finds that the preponderance of the evidence is against the Veteran's claim. While his STRs reflect treatment for a right shoulder injury in September 1976, the injury appears to have been acute and not severe. Additionally, his pre-discharge medical examination and Report of Medical History are negative for shoulder conditions. Furthermore, the Veteran has asserted that his left shoulder was the shoulder that was injured during service, not his right shoulder. The Veteran's VA treatment records do not reflect chronicity of care since active service. The August 2015 VA examiner found that the Veteran's in-service shoulder injury was most likely acute, and his current right shoulder condition was less likely than not related to service. Based on these facts, the Board concludes that the preponderance of the evidence is against finding that the Veteran's claimed condition began during or as a result of active service. Accordingly, the claim for service connection for a right shoulder condition is denied. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran's claims, that doctrine is not applicable in this appeal. 38 U.S.C. § 5107(b). REASONS FOR REMAND 1. Entitlement to service connection for cervical segmental dysfunction, neck pain, and myofascitis and arthritis is remanded. The Veteran asserts that his neck disability arose during or as a result of his active service. His service treatment records (STRs) reflect treatment for back and neck soreness, with decreased range of motion, after rappelling down a cliff in March 1979. He given Tylenol to treat his pain. Notably, his November 1975 entrance medical examination and Report of Medical History and his November 1979 pre-discharge medical examination and Report of Medical History are negative for evidence of neck injuries or conditions. A July 2014 private DBQ for neck conditions by the Veteran's chiropractor reflects the Veteran having a history of chronic neck pain, with cervical segmental dysfunction, with neck pain and myofascitis, diagnosed in June 2014. The chiropractor stated the Veteran's conditions were due to years of wear and tear, consistent with the Veteran's reports of his in-service duties. Consequently, the chiropractor concluded that the Veteran's current symptoms were a result of his military service. In a June 2014 medical opinion by the Veteran's chiropractor, the chiropractor stated that the Veteran experienced chronic neck and back pain. They state that while they had not been able to review all of the Veteran's treatment records, they felt that the conditions were aggravated by active service or secondary to a service-connected disability. The Board notes that the Veteran has not been afforded a VA examination to address the nature and etiology of his claimed neck condition. Accordingly, this claim must be remanded for further development. 2. Entitlement to service connection for bilateral pes planus is remanded. The Veteran's STRs reflect preexisting pes planus in his entrance November 1975 medical examination. However, they are negative for other complaints or treatment for pes planus. His November 1979 medical examination is negative for evidence of worsening of the preexisting condition. The November 1979 Report of Medical History is positive for "foot trouble" during service. During his Board hearing, the Veteran testified that he was given boots that did not fit properly during training, and this aggravated his foot condition. He asserted that he experienced chronic calluses, tenderness, and pain. The Board notes that the Veteran has not been afforded a VA examination to address the nature, etiology, and potential aggravation of his bilateral pes planus. Accordingly, this claim must be remanded for further development. 3. Entitlement to service connection for left shoulder osteoarthritis is remanded. The Veteran asserts that his left shoulder disability arose during or as a result of his active service. His STRs reflect treatment for a right shoulder injury in September 1976. His November 1979 Report of Medical History was positive for broken bones and swollen or painful joints, but neither that report nor the November 1979 medical examination noted any shoulder conditions. In an April 2005 statement in support of his claim, the Veteran asserted that he injured his left shoulder in March 1979, during a sports game, when an opposing player ran over him. In an April 2005 Decision Review Officer (DRO) conference, the Veteran asserted that he had experienced two injuries to his left shoulder during service and chronic pain in the left shoulder since service. He stated that in-service treatment records concerning his right shoulder were in error, as his left shoulder was the shoulder that was injured. During the Veteran's August 2015 VA examination for shoulder and arm conditions, the examiner noted that x-rays demonstrated advanced osteoarthritis of the acromioclavicular joints. The examiner opined that the Veteran's current right shoulder condition was less likely than not related to service. Their rationale was based on the in-service right shoulder injury being acute only, the lack of evidence of chronicity of care, and the fact that there was insufficient evidence tying the current right shoulder complaints to his active service. In a January 2018 Form 9 statement, the Veteran asserted that an in-service rappelling accident caused left and right shoulder injuries, and he had experienced chronic pain since those injuries. The Board notes that while the Veteran's left shoulder was examined during the August 2015 VA examination, no etiology opinion was provided. Accordingly, this claim must be remanded for an addendum opinion. 4. Entitlement to service connection for residuals of a traumatic brain injury (TBI) is remanded. The Veteran asserts that he experiences residuals of an in-service TBI. His VA treatment records reflect a diagnosis for TBI in February 2015, with earlier treatment in October 2014. During the Veteran's August 2015 VA examination for residuals of TBI, the VA examiner stated that they were unable to confirm a diagnosis of TBI due to insufficient evidence. The Veteran reported injuring his head during service in October 1978 and November 1978, after which he experienced hearing loss and a headache. The Veteran reported chronic hearing loss, vertigo, and memory loss, which he attributed to these in-service head injuries. The examiner stated that the Veteran reported chronic headaches and mild memory loss. However, there were no symptoms at the time of the examination. The examiner opined that his current complaints were more likely due to another etiology and not related to TBI. The Board finds the August 2015 VA examination inadequate for adjudication purposes. First, the VA examiner did not discuss the evidence of treatment for TBI in the Veteran's VA treatment records. Second, while the examiner found that the Veteran's current complaints were most likely due to another etiology, the examiner did not explain why that was so or what the alternative etiology was. Accordingly, this claim must be remanded for an addendum VA medical opinion. 5. and 6. Entitlement to service connection an acquired psychiatric disorder, to include MDD and PTSD, is remanded The Veteran asserts that he experienced MDD and PTSD as result of his active service. In an April 2017 statement in support of his claim for PTSD, the Veteran reported in-service stressors due to personal assaults and punishments due to hearing loss, which is service connected. The Veteran's VA treatment records reflect treatment and prescribed medication for MDD. See, e.g., June 2017 VA treatment records. Ina January 2018 Form 9 statement, the Veteran repeated his assertions that his depression and PTSD were caused by mistreatment due to his hearing loss, and he suffered humiliation and embarrassment due to not being able to hear supervisors and fellow service members. The Veteran has not been afforded a VA examination for his MDD and claimed PTSD. Accordingly, these claims must be remanded for additional development. The matters are REMANDED for the following actions: 1. Send the Veteran a letter (i.e., stressor verification form) requesting any pertinent information to assist VA in attempting to verify any in-service stressors. Following receipt of any response, appropriate action should be taken to attempt to verify any reported stressors that are capable of verification, to include contacting the appropriate service department entities and any other appropriate sources. If the search for corroborating records leads to negative results, the RO must notify the Veteran and his representative of this fact, explaining the efforts taken, describing any further action to be taken, and affording them the opportunity to respond. The RO should also follow up on any additional action suggested by each appropriate source contacted. Consideration should be given to the April 2021 hearing testimony and lay statements of record. 2. After all development has been undertaken, schedule the Veteran for a VA examination with a psychiatrist or psychologist to determine the etiology of all psychiatric disorders, to include MDD and PTSD, if present. The entire claims file, including a copy of this remand, must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner is asked to opine on the following matters: (a) Identify all psychiatric disorders present during the pendency of the appeal. (b) For each non-PTSD psychiatric disorder diagnosed (e.g., MDD), provide an opinion regarding whether it is at least as likely as not (a 50 percent or greater probability) that each disorder had its onset in, or is otherwise related to, active service. (c) If stressor verification is accomplished and a diagnosis of PTSD is deemed appropriate, the examiner should also opine as to whether any of the identified stressor(s) are adequate to support the diagnosis. All opinions must be supported by a rationale. 3. Schedule the Veteran for an appropriate VA examination to evaluate the nature and likely etiology of the cervical spine condition. The examiner shall note in the report that the entire electronic claims file has been reviewed, to include this Remand. Any indicated special testing should be undertaken. The examiner should address the following matters: (a) Identify all cervical spine or neck conditions present during the period on appeal. (b) For each diagnosed condition, the examiner is asked to opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed cervical spine condition was incurred in or otherwise is attributable to service. In setting forth this opinion, the examiner must consider, and comment upon as necessary, documentation of the Veteran having sought treatment for neck symptomatology in service. The examiner must also consider, and comment upon as necessary, lay testimony regarding an incident in service in which the Veteran attests that his neck and back were "snapped" during a rappelling accident in March 1979. All opinions must be supported by a thorough rationale. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of his pes planus. The examiner should answer the following: (a) Did the Veteran's bilateral pes planus clearly and unmistakably preexist his active service? (b) If the answer to (a) is yes, is there clear and unmistakable evidence that the Veteran's preexisting pes planus was not aggravated beyond its natural progress by his active service? Clear and unmistakable evidence means evidence that cannot be misinterpreted and misunderstood, i.e., undebatable. Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). Temporary or intermittent flare-ups of a preexisting injury or disease are not considered "aggravation in service." (c) If the answer to (a) is no, is it at least as likely as not (a 50 percent or greater probability) that the Veteran's bilateral pes planus arose during or as a result of his active service. A detailed rationale for the opinion must be provided. 5. Obtain an addendum medical opinion from the August 2015 VA examiner, or another qualified examiner, to address the nature and etiology of the Veteran's claimed left shoulder condition. The examiner is asked to review the claims file, including this remand, and then opine on the following matters: (a) Identify all left shoulder conditions present during the appeal, even if currently resolved, including complaints of pain if they are severe enough to result in functional impairment. (b) For each diagnosed left shoulder condition, opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the condition arose during or as a result of the Veteran's active service. A complete rationale should be provided for all opinions. 6. Obtain an addendum medical opinion from the August 2015 VA examiner, or another qualified examiner, to address the nature and etiology of the Veteran's claimed TBI condition. The examiner is asked to review the claims file, including this remand, and then opine on the following matters: (a) Identify all residuals of TBI present during the appeal, even if currently resolved, including complaints of pain if they are severe enough to result in functional impairment. (b) For each diagnosed TBI-related condition, opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the condition arose during or as a result of the Veteran's active service. A complete rationale should be provided for all opinions. If there is an etiology for the Veteran's complaints other than his reported TBI, this alternative etiology should be explained in detail. 7. With regard to all examination requests, the Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Hicks, 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.