Citation Nr: 21041288 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 17-04 573A DATE: July 8, 2021 REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a headache disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1970 to July 1999. This matter is before the Board of Veterans' Appeals (Board) following a Board Remand in December 2019. In August 2019, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. As noted above, the Board remand the issues on appeal in December 2019 for additional development. Specifically, the Board directed that the Veteran be scheduled for VA examinations to determine the nature and etiologies of his lumbar spine disorder, right knee disorder, left knee disorder, right ankle disorder, headache disorder, and left shoulder disorder. In addition to addressing specific in-service complaints related to the Veteran's lumbar spine, left knee, and left shoulder, the Board directed that the examiner, "consider and address the nature of the Veteran's in-service duties which involved heavy lifting, running, marching, and exposure to intense vibrations from helicopters while performing as a pilot, as well as his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of right ankle symptomology since service." The Veteran underwent VA examinations in January 2021; however, the examiner did not address the nature of the Veteran's in-service duties or his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of right ankle symptomology since service. After the case was returned to the Board and the Veteran's representative submitted a Post-Remand Brief, the Veteran was provided with additional VA examinations for his lumbar spine disorder, right knee disorder, left knee disorder, right ankle disorder, and left shoulder disorder. Although the VA examiner addressed the dates of onset, details of onset, and course since onset for the Veteran's disorders, the examiner did not provide etiology opinions or address the nature of the Veteran's in-service duties or his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of symptomology since service. Therefore, a remanded is required to obtain an addendum opinion which addresses the nature of the Veteran's in-service duties and his statements regarding the stigma against seeking in-service medical treatment and his reports of continuity of symptomology since service. The matters are REMANDED for the following action: Obtain addendum opinions from an appropriate clinician regarding whether the Veteran's it is at least as likely as not (50 percent or greater probability) that the Veteran's lumbar spine disorder, right knee disorder, left knee disorder, right ankle disorder, left shoulder disorder, and headaches had their clinical onset during active duty service or are related to any in-service disease, event, or injury. (a) Lumbar Spine For each lumbar spine disorder found to be present, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's lumbar spine disorder had its clinical onset during active duty service or is related to any in-service disease, event, or injury. In providing this opinion, the examiner should consider and address the nature of the Veteran's in-service duties which involved heavy lifting, running, marching, and exposure to intense vibrations from helicopters while performing as a pilot, as well as his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of back symptomology since service. (b) Left Shoulder For each left shoulder disorder found to be present, or left shoulder pain that results in functional impairment such that it may be considered a disability, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any such disability had its clinical onset during active duty service or is related to any in-service disease, event, or injury. In providing this opinion, the examiner should consider the service treatment records dated in May 1998 showing that the Veteran had injured his left shoulder four months prior and was still experiencing pain on motion of the shoulder. The examiner should also consider and address the nature of the Veteran's in-service duties which involved heavy lifting, running, marching, and exposure to intense vibrations from helicopters while performing as a pilot, as well as his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of left shoulder symptomology since service. (c) Right Knee For each right knee disorder found to be present, or right knee pain that results in functional impairment such that it may be considered a disability, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any such disability had its clinical onset during active duty service or is related to any in-service disease, event, or injury. In providing this opinion, the examiner should consider and address the nature of the Veteran's in-service duties which involved heavy lifting, running, marching, and exposure to intense vibrations from helicopters while performing as a pilot, as well as his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of right knee symptomology since service. (d) Left Knee For each left knee disorder found to be present, or left knee pain that results in functional impairment such that it may be considered a disability, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any such disability had its clinical onset during active duty service or is related to any in-service disease, event, or injury. In providing this opinion, the examiner should consider the service treatment record dated July 9, 1996 showing that the Veteran had fallen onto his left knee and was diagnosed as having prepatellar bursitis. The examiner should also consider and address the nature of the Veteran's in-service duties which involved heavy lifting, running, marching, and exposure to intense vibrations from helicopters while performing as a pilot, as well as his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of left knee symptomology since service. (e) Right Ankle For each right ankle disorder found to be present, or right ankle pain that results in functional impairment such that it may be considered a disability, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any such disability had its clinical onset during active duty service or is related to any in-service disease, event, or injury, to include the Veteran's in-service right ankle pain in August 1981. In providing this opinion, the examiner should consider and address the nature of the Veteran's in-service duties which involved heavy lifting, running, marching, and exposure to intense vibrations from helicopters while performing as a pilot, as well as his statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of right ankle symptomology since service. (f) Headaches For each headache disorder found to be present, or head pain that results in functional impairment such that it may be considered a disability, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that any such disability had its clinical onset during active duty service or is related to any in-service disease, event, or injury, to include the Veteran's reported in-service headaches. See STRs showing complaints of headaches in January 1981, July 1985, March 1987, and January 1998. In providing this opinion, the examiner should consider and address the Veteran's statements regarding the stigma against seeking in-service medical treatment and his complaints of a continuity of headache symptomology since service. * In providing all of the above requested opinions, the examiners should consider the Veteran's description of in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disabilities are known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? All examination findings, along with a complete rationale for all opinions expressed, should be set forth in the examination reports. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Olson, Patricia 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.