Citation Nr: 22010503 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 14-35 424 DATE: February 23, 2022 REMANDED Entitlement to service connection for a right shoulder 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 1991 to December 1994. This matter came before the Board of Veterans Appeals (Board) on appeal from a November 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran's Law Judge during a June 2017 hearing. The transcript of the hearing is of record. A March 2018 Board decision dismissed the issue of service connection for a heart disability and remanded the remaining issues on appeal for further development. A July 2020 Board decision denied service connection for left leg shin splints and right ear hearing loss disabilities and remanded the remaining issues on appeal for further development. An April 2021 Board decision remanded the issues on appeal again for additional development. A February 2020 rating decision granted service connection for traumatic brain injury (TBI) and a left ear hearing loss disability, and a January 2021 rating decision granted service connection for lumbar degenerative disc disease, left and right knee degenerative arthritis and blurred vision. As those decisions constituted a full grant of the benefit sought on appeal for those issues, they are not before the Board. 1. Entitlement to service connection for a right shoulder disability 2. Entitlement to service connection for a left shoulder disability The April 2021 Board remand directed that a new etiology opinion be obtained for the Veteran's right and left shoulders. At the time, it was noted that the Veteran had been diagnosed with bilateral shoulder strain. he Veteran was given a new VA examination and a new opinion was provided in December 2021. The Board finds that the December 2021 VA opinion is inadequate. The remand directives specifically stated that an in-person examination was not required unless deemed necessary by the provider, and that an opinion regarding the etiology of the Veteran's bilateral shoulder disability should consider all the evidence of record, to include the Veteran's lay statements. However, the December 2021 VA provider declined to provide an etiology opinion as the Veteran declined range of motion testing during the December 2021 examination due to pain. She did not explain the necessity or relevancy of updated range of motion testing in rendering an etiology opinion. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The December 2021 VA provider declined to provide an etiology opinion without including sufficient rationale as to why such an opinion could not be rendered with the information already of record. The opinion is therefore inadequate, and remand is required to obtain an adequate etiology opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's right and left shoulder disabilities from a different provider than the ones who rendered the May 2021 and December 2021 opinions. An in-person examination is not required unless deemed necessary by the provider. The provider should review the file and provide a complete rationale for all opinions expressed. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral shoulder strain disabilities are related to his active service, to include wear and tear while working as a Bradley infantry crewmember within a confined space, as well as the documented in-service assault. In providing the opinion, the provider should consider and discuss any lay statements of record, to include the Veteran's statements regarding the onset and persistence of his symptoms. If the provider finds that the lay evidence of record does not support a finding of nexus, the provider should indicate why that is the case. The provider is advised that competent lay statements should not be disregarded merely because they are unaccompanied by contemporaneous medical evidence. (Continued on the next page) 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Bock 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.