Citation Nr: 22010705 Decision Date: 02/24/22 Archive Date: 02/24/22 DOCKET NO. 14-35 293 DATE: February 24, 2022 REMANDED Entitlement to service connection for a right shoulder disability, to include as secondary to a service-connected disability is remanded. Entitlement to service connection for a left shoulder disability, to include as secondary to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1978 to June 1995. He testified before the undersigned in November 2015; a transcript of the hearing is associated with the record. The claim has been before the Board several times, most recently in June 2021. 1. Entitlement to service connection for a right shoulder disability, to include as secondary to a service-connected disability. 2. Entitlement to service connection for a left shoulder disability, to include as secondary to a service-connected disability. The claims must be remanded again because it appears the Agency of Original Jurisdiction (AOJ) returned them to the Board prematurely. After undertaking the development directed in the Board's June 2021 remand, the AOJ issued a Supplemental Statement of the Case (SSOC) in October 2021 and notified the Veteran in November 2021 that his appeal was returned to the Board. Despite that, the AOJ continued to develop the claims and added additional evidence to the record. While the AOJ addressed the additional evidence in a subsequent SSOC, the claims must be remanded again because the medical opinions are inadequate. The September 2021 opinion is inadequate because the examiner considered the wrong standard for secondary aggravation. The AOJ obtained a January 2022 opinion in which the examiner used the correct standard but the rationale provided makes that opinion inadequate. The examiner opined that it was less likely than not the Veteran's shoulder disabilities were aggravated or increased by his service-connected back or neck disabilities as there was no evidence in the file showing the shoulder conditions were aggravated or increased by the service-connected disabilities. It does not appear that the opinion is based on a review of the complete record. In a May 2010 private treatment record, the Veteran stated pain radiated from his neck down to his arms in his right shoulder and was diagnosed with right shoulder pain and right upper extremity radiculopathy. A May 2012 VA Examination showed the Veteran revealed a grinding sensation in his neck while performing active range of motion. A December 2019 VA opinion stated that cervical spine arthritis can cause radicular symptoms to the shoulder and that pain can radiate from the neck to the shoulders. Therefore, a remand is necessary to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Forward copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion on the nature and likely etiology of the bilateral shoulder disabilities. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The examiner is asked to answer the following questions: (a) For each diagnosed shoulder disability, is it at least as likely as not (i) caused by or (ii) aggravated by (defined as any increase in disability) the Veteran's service-connected back or neck disabilities, to include neurological manifestations? In answering the foregoing, the clinician must consider and discuss as appropriate the following: (i) the May 2010 treatment note that pain radiates from his neck down his arm, (ii) the May 2010 diagnosis of radiculopathy in the right upper extremities, (iii) the May 2012 report of a grinding sensation in the neck performing active range of motion, and (iv) the December 2019 opinion that the cervical spine can cause radiculopathic symptoms in the shoulders and that pain can radiate from the neck to the shoulders. The examiner must provide reasons for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the incorrect standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.