Citation Nr: 22015327 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 17-45 095 DATE: March 17, 2022 REMANDED Entitlement to service connection for a right shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1970 to May 1974. This appeal to the Board originates from an August 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). The Veteran testified in support of this claim during a "virtual" teleconference hearing in October 2021 before the undersigned Veterans Law Judge of the Board. A transcript of the hearing is of record. Entitlement to service connection for a right shoulder disability is remanded. The primary basis of this claim is that the Veteran's right shoulder disability was caused or is aggravated by his already determined to be service-connected left shoulder disability, so this claim is rooted in the notion of secondary service connection. 38 C.F.R. § 3.310(a) and (b); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). A May 2016 VA examination report shows a diagnosis of bilateral, so right and left, acromioclavicular (AC) joint osteoarthritis. The examiner indicated it is less likely than not the Veteran's right shoulder disability is proximately due to or the result of his left shoulder disability. This examiner indicated the Veteran's diagnoses are separate, based on opposing lateral entities of each shoulder. But this opinion is inadequate since the examiner did not also comment on whether the service-connected left shoulder disability alternatively is aggravating the right shoulder disability. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (holding that a medical opinion focusing solely on causation is inadequate to additionally address whether a service-connected disability aggravates another condition). Two opinions are required for secondary-service-connection claims: 1. Is the claimed disorder "caused by" or "due to" the service-connected disability? AND 2. Is the claimed disorder "aggravated by" the service-connected disability (Allen Aggravation)? Evidence of baseline disability is necessary to establish entitlement to service connection for aggravation of a nonservice-connected condition by a service-connection condition (regulatory change effective from September 2006). An opinion that something "is not related to" or "is not due to" does not answer the question of aggravation. See Allen, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310(b). During his October 2021 hearing before this Board, the Veteran expounded that he believes the continued worsening of his left shoulder disability during the many years since his precipitating injury in service has required him to continually overcompensate for this left shoulder disability which, in turn, over time has required that he continually use his right arm and shoulder more in daily activity (i.e., he has had to favor his right shoulder over his left shoulder). However, he conceded that his doctors have not actually outright told him that his right shoulder disability is secondary to his service-connected left shoulder disability. Therefore, to provide him the opportunity to obtain and submit a supporting medical nexus opinion affirming this posited correlation, the Board held the record open for an additional 90 days following the hearing, but the Veteran and his representative preemptively cautioned there was no assurance he would be able to obtain this needed supporting medical opinion. His representative nonetheless indicated that it could not hurt to ask. But it now has been well more than 90 days since the hearing, and no such supporting medical nexus opinion has been submitted or even indicated as forthcoming. That notwithstanding, the Board is requesting supplemental medical comment on this determinative issue of aggravation since another potential basis of entitlement and because the prior May 2016 VA examiner's opinion, as already mentioned, is inadequate in not commenting on this other possibility. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (Once VA endeavors to provide an examination for a medical opinion, even if not statutorily obligated to, it must ensure they are adequate, else, notify the claimant why cannot or will not be provided.) Accordingly, this claim is REMANDED for the following action: Obtain an addendum medical opinion concerning the etiology of the Veteran's right shoulder disability. All relevant evidence, including a complete copy of this remand, must be made available to the examiner. The examiner is asked to specifically respond to the following: If, as the prior May 2016 VA examiner concluded, the Veteran's service-connected left shoulder disability did not cause his right shoulder disability, is it nevertheless as likely as not (50% or better probability) his service-connected left shoulder disability alternatively is aggravating his right shoulder disability? *In other words, this additional comment on aggravation is still needed. *The examiner must also remain mindful that a precedent case clarified that secondary service connection under 38 C.F.R. § 3.310(b) does not require "permanent" worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). Provide rationale for the opinion, regardless of whether favorable or conversely unfavorable to this claim, preferably citing to findings or other evidence in the file supporting conclusions and/or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Poindexter 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.