Citation Nr: 22016156 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 17-14 025A DATE: March 21, 2022 REMANDED Entitlement to service connection for left shoulder condition is remanded. REASONS FOR REMAND The Veteran served on active duty in from February 2011 to February 2015, from June 2019 to September 2019, and from October 2019 to September 2020. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). When this claim was most recently before the Board in August 2021, it was remanded to obtain private treatment records pertinent to the Veteran's left shoulder disability claim, and to obtain an addendum medical opinion to determine the nature and etiology of the left shoulder disability. In a September 2021 subsequent development letter, the Agency of Original Jurisdiction (AOJ) requested that the Veteran complete and returned the enclosed VA Form 21-4142a and VA Form 21-4142 documents, along with any information concerning outstanding private treatment records that were pertinent to his left shoulder disability claim. The Veteran never responded. Additionally, an addendum medial opinion was obtained in November 2021. Entitlement to service connection for left shoulder condition is remanded. The Veteran contends that his current left shoulder disability is related to an injury incurred in-service when he underwent rigorous training and carried heavy equipment. He maintains that he had continued to experience left shoulder experience pain since that in-service occurrence. When this appeal was last remanded in August 2021, the Board advised the examiner chosen to provide the addendum medical opinion that the Veteran is competent to report his medical history, including when his symptoms began, and such reports must be acknowledged and considered in formulating any opinion. The remand directed that the Veteran's lay contentions must be considered and weighed in making the determination as to whether a nexus exists between the claimed disability and military service. An addendum opinion was obtained in November 2021. The examiner opined that the Veteran's left shoulder disability was less likely than not incurred in or caused by service. Although the examiner noted the Veteran's lay contentions concerning the onset of his symptoms in her rationale, she provided a negative etiology opinion because the Veteran denied during his separation examination and the nature of his most recent left shoulder examination was "benign," and did not suggest a significant chronic shoulder impairment/condition that was likely to date back to military service. However, she also noted that February 2017 treatment notes from Kaiser were outstanding but could potentially establish a stronger nexus to service. Given that it appears there is at least some possibility that the Veteran's lay statements with regard to onset of his symptoms, if found to be credible could potentially support a finding of medical nexus, remand of this claim is required for procurement of an addendum opinion commenting on whether the Veteran's current left shoulder condition could be related to the reported in-service event of rigorous training and carrying heavy equipment, notwithstanding the denial of shoulder symptoms recorded at the Veteran's separation examination. Moreover, as this claim is being remanded due to an inadequate addendum opinion, the Veteran should be provided with an additional opportunity to complete and return VA Form 21-4142 and VA Form 21-4142a documents for any private treatment records pertinent to his left shoulder disability. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide information as to any outstanding private treatment records pertinent to his left shoulder disability, to include records from Kaiser. After obtaining the necessary authorization from the Veteran, the AOJ must make reasonable efforts to obtain any identified outstanding records. 2. Obtain an addendum VA medical opinion from an appropriate clinician aside from the examiner that provided the September 2020 and November 2021 opinions to determine the nature and etiology of the Veteran's left shoulder disability. The entire claims file must be made available to and reviewed by the examiner. If the examiner finds that a physical examination is needed, one should be scheduled. Thereafter, the examiner is asked to respond to the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran's left shoulder disability was incurred in or caused by an in-service injury, event, or illness to include in-service injury related to rigorous training and carrying heavy equipment? The examiner is reminded that the term "at least as likely as not" does not mean "within the realm of possibility." Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it. It should be noted that a lack of documented treatment for the given disability in service, while probative, cannot serve as the sole basis for a negative finding. Additionally, for the purposes of provided a medical nexus opinion. The examiner is advised that the Veteran is competent to report his medical history, including when his symptoms began, and such reports must be acknowledged and considered in formulating any opinion. The Veteran's lay contentions must be considered and weighed in making the determination as to whether a nexus exists between the claimed disability and military service. A full rationale must be provided for any opinion offered. Reference to findings from identified studies is preferred over reference to medical literature in the abstract. If the examiner relies on his or her medical experience as a rationale, it is appropriate to identify the specifics such as an estimate of the number of patients the examiner has seen with similar conditions, the time the examiner had been practicing in the field, or any relevant specialized education or training experiences that go beyond the examiner's degree or accreditation. M. COYNE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fairlie, 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.