Citation Nr: 22015355 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 18-27 924 DATE: March 17, 2022 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1998 to July 2002 in the United States Army. The Veteran testified at January 2022 hearing before the undersigned. A transcript is associated with the record. The Veteran claims service connection for major depressive disorder and anxiety; the psychiatric claim has been recharacterized as shown above. Clemons v. Shinseki, 23 Vet. App. 1 (2009). There may be outstanding relevant VA treatment records that must be obtain. At the hearing, the Veteran said that he was treated at a VA Medical Center and has continued to receive VA treatment. Those records must be obtained on remand 1. Service connection right shoulder condition is remanded. The Board cannot make a fully-informed decision on the claim because no VA examiner has adequately opined whether the Veteran's current right shoulder disability is etiologically related to his documented in-service right shoulder injury. The Veteran underwent a VA examination in January 2016 and was diagnosed with a right shoulder strain. In an accompanying opinion the examiner concluded that the disability is less likely than not etiologicaly related to the in-service injury, citing a normal separation examination and a post-service right shoulder injury. However, the Veteran has testified that his right shoulder symptoms were not "acute" and did not resolve during service, and that he did not continue to seek treatment for them until after his post-service injury. Therfore, an addendum opinion is necessary to address this competent testimony. 2. Service connection right ankle condition is remanded. 3. Service connection left ankle condition is remanded. The Board cannot make a fully-informed decision on the ankke claims because no VA examiner has opined whether any diagnoseable ankle disabilities are etiologically related to active duty parachute jumps. The Veteran testified that he injured his ankles when landing during parachute jumps and did not seek treatment. The Veteran also testified that he continued to experience stiffness and pain in his ankles after service. Therefore, remand is necessary to obtain a VA examination and opinion. These competent statements must be addressed by the examiner when providing a service connection opinion. 4. Service connection neck condition is remanded. The Board cannot make a fully-informed decision on the claim because no VA examiner has opined whether any diagnoseable neck disability is etiologically related to active duty parachute jumps. The Veteran testified that he injured his neck on the same jump that resulted in his noted in-service right shoulder injury. The Veteran also testified that he mentioned shooting pain into his neck during in-service treatment for his shoulder injury and indicated that the neck disability may be secondary to his right shoulder disability. Therefore, remand is necessary to obtain a VA examination and opinion. 5. Service connection for an acquired psychiatric disorder is remanded. The Board cannot make a fully-informed decision on the psychiatric claims because no VA examiner has opined whether any diagnoseable psychiatric disorder is etiologically related to his claimed traumatic experinces with parachute jumps in active duty service. The Veteran sepcifically testified regarding two instances (a "map of the earth" flight and a fellow service-member being tangled in his parachute risers during a jump), and the symptoms he has experienced in re-living those incidents. Therefore, remand is necessary to obtain a VA examination and medical opinion. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from October 2016 to the Present. 2. After completion of the above, obtain an addendum opinion from an appropriate clinician regarding the nature and likely etiology of any diagnosed right shoulder disability. Copies of all pertinent records must be made available to the examiner. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The examiner must answer the following: (a) Is it at least as likely as not that the Veteran's current right shoulder disability is related to his in-service right shoulder injury? The examiner must specifically address the Veteran's competent testimony that he continued to experience right shoulder symptoms following his in-service treatment and they got worse following his post-service injury. 3. After completion of paragraph 1, schedule the Veteran for a VA examination to determine the nature and likely etiology of any identified left and right ankle disabilities. Copies of all pertinent records must be made available to the examiner for review. Based on an examination and review of the record, the examiner should provide opinions as to the following: (a) Identify all diagnosed ankle disabilities since October 2016. (b) For each diagnosed left or right ankle disability, is it at least as likely as not related to an in-service injury, event, or disease, including the Veteran's parachute jumps during service? (c) If no specific left or right ankle disability is diagnosed, the examiner must consider whether any pain results in functional impairment of earning capacity. For any identified functional impairment of either ankle, the examiner must opine whether it is at least as likely as not related to an in-service injury event, or disease, including the Veteran's parachute jumps during service. In providing the requested opinion, the examiner must address the Veteran's competent testimony that he did not seek in-service treatment for ankle injuries consider the Veteran's description of his/her in-service injury and 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 injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 4. After completion of paragraph 1, schedule the Veteran for a VA examination to determine the nature and likely etiology of any identified neck disability. Copies of all pertinent records must be made available to the examiner for review. Based on an examination and review of the record, the examiner should provide opinions as to the following: (a) Identify all diagnosed neck disabilities since October 2016. (b) For each diagnosed neck disability, is it at least as likely as not related to an in-service injury, event, or disease, including the Veteran's parachute jumps during service? The examiner must specifically address the Veteran's competent testimony that he injured his neck during the same jump that injured his shoulder during service. (c) If no specific neck disability is diagnosed, the examiner must consider whether any pain results in functional impairment of earning capacity. For any identified functional impairment of the neck, the examiner must opine whether it is at least as likely as not related to an in-service injury event, or disease, including the Veteran's parachute jumps during service. (d) for any diagnosed neck disability or identified functional impairment, it is at least as likely as not (i) caused by the right shoulder disability or (ii) aggravated by (any increase in disability) the right shoulder disability? If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? In providing the requested opinion, consider the Veteran's description of his in-service injury and 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 injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 5. Schedule the Veteran for a VA examination to determine the nature and likely etiology of any diagnosed psychiatric disabilities. Copies of all pertinent records must be made available to the examiner for review. The examiner is asked to provide a response to the following: (a) Identify all psychiatric disabilities diagnosed since October 2016. (b) Is it at least as likely as not that any diagnosed psychiatric disorder is related to service, including the jump-related incident described by the Veteran in the Veteran's sworn testimony, specifically the map of the earth flight and the incident where a fellow service-member became stuck in the Veteran's parachute risers? A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 6. Confirm that the VA medical opinions provided comport with this remand, specifically that the standard for the secondary aggravation opinions is any increase in disability, not the 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 P.S. McLeod 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.