Citation Nr: 22015372 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 19-28 482 DATE: March 17, 2022 REMANDED Entitlement to service connection for a left shoulder disorder, to include as secondary to service-connected right shoulder degenerative arthritis, is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1992 to August 2017. He is the recipient of numerous awards and decorations, to include the Combat Action Ribbon. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in March 2018 by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. 1. Entitlement to service connection for a left shoulder disorder, to include as secondary to service-connected right shoulder degenerative arthritis. The Veteran contends that he has a left shoulder disorder that is directly related to his military service or, alternatively, secondary to his service-connected right shoulder degenerative arthritis. Specifically, at the June 2021 Board hearing, he stated that such disorder was a result of general wear and tear from carrying heavy equipment and constant traveling during his military service, to include while serving in combat. He further stated that, as he was already having issues with his right shoulder while in service, he believed he overcompensated by using his left shoulder at such time. Additionally, the Veteran noted that he began experiencing left shoulder symptoms during service and such continued to the present time. In May 2017, the Veteran was afforded a VA examination in connection with the instant claim. At such time, the examiner found that he did not have a diagnosis of a left shoulder disorder. Here, he noted that an X-ray showed mild osteopenia; however, such was an incidental finding and no additional diagnosis was warranted. Similarly, following examination, a February 2018 VA examiner indicated that the Veteran's left shoulder was undamaged with no abnormalities. However, an October 2017 VA treatment record reflects an assessment that the Veteran's signs and symptoms were consistent with left shoulder degenerative changes of the glenohumeral joint and supraspinatus tendinitis. Further, a May 2018 MRI of the Veteran's left shoulder reveals an impression of moderate to advanced supraspinatus tendinosis and mild insertional subscapularis tendinosis. Thus, the Board finds a remand is warranted to afford the Veteran another VA examination to determine whether he has a current left shoulder disorder that is directly related to his military service and/or secondary to his service-connected right shoulder degenerative arthritis. 2. Entitlement to service connection for a left knee disorder. 3. Entitlement to service connection for a right knee disorder. The Veteran contends that he has a bilateral knee disorder as a result of performing his physical duties, to include carrying heavy equipment and jumping out of helicopters while serving in combat, which also led to wear and tear over time. Additionally, his service treatment records (STRs) reflect that, in August 2004, the Veteran complained of left knee pain following a motorcycle accident, and an assessment of left knee contusion was noted. Further, on his February 2017 Report of Medical History, the Veteran indicated that he had knee trouble. Here, it was noted that he experienced aching and tenderness of his knees with cracking and popping, was unable to kneel on hard surfaces, and standing for long periods caused discomfort. A February 2017 STR reflects the Veteran's complaint of chronic bilateral knee pain. Additionally, he reports that he has experienced pain related to his knee joints since his military service, which resulted in limitation of motion and impacted his ability to do his job as a Catholic priest as he had difficulty kneeling on hard surfaces. However, a June 2017 VA examiner determined that, despite the Veteran's subjective reports of pain and flare-ups, he did not have a diagnosis of a left or right knee disorder as such were normal on physical examination. Thus, no etiological opinion was offered. However, the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Consequently, the Board finds another VA examination is warranted to determine whether the Veteran has a current left and/or right knee disability related to service. The matters are REMANDED for the following action: 1. Afford the Veteran an appropriate VA examination to determine the nature and etiology of his claimed left shoulder disorder. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests should be accomplished. Thereafter, the examiner should address the following inquiries: (A) Identify all current left shoulder disorders that have been present at any point pertinent to the Veteran's November 2017 claim, even if such is asymptomatic or has since resolved. In this regard, the examiner should consider the diagnoses of supraspinatus/subscapularis tendinosis/tendonitis as shown by October 2017 and May 2018 VA treatment records. If no left shoulder disorder is diagnosed, the examiner should offer an opinion as to whether the Veteran's reported symptomatology results in functional impairment of earning capacity. If so, the examiner is advised that he or she should accept that he has a disability for the purpose of rendering the opinion requested below. (B) For each left shoulder disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, the Veteran's military service, to include as a result of his combat-related duties. (C) For each left shoulder disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such is caused or aggravated by the Veteran's service-connected right shoulder degenerative arthritis, to include as the result of overcompensation. For any aggravation found, the examiner should state, to the best of their ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. A rationale for any opinion offered should be provided. 2. Afford the Veteran an appropriate VA examination to determine the nature and etiology of his claimed left and right knee disorders. The record, to include a copy of this Remand, must be made available to the examiner, and all indicated tests should be accomplished. Thereafter, the examiner should address the following inquiries: (A) Identify all current left and right knee disorders that have been present at any point pertinent to the Veteran's November 2017 claim, even if such is asymptomatic or has since resolved. If no left or right knee disorder is diagnosed, the examiner should offer an opinion as to whether the Veteran's reported bilateral knee symptomatology results in functional impairment of earning capacity. If so, the examiner is advised that he or she should accept that he has a disability for the purpose of rendering the opinion requested below. (C) For each knee disability, offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, the Veteran's military service, to include his combat-related duties and/or his reports of knee pain as documented in the STRs. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Koria B. Stanton, 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.