Citation Nr: 22016428 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 16-21 814 DATE: March 22, 2022 REMANDED Entitlement to service connection for a right shoulder disability is remanded. REASONS FOR REMAND The Veteran served with the Air Force Reserves and National Guard, with periods of active duty from May 1974 to November 1974 and December 1998 to March 1999, with additional periods of active duty for training (ACDUTRA). This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in February 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the appeal in May 2020 and April 2021 for additional development and it now returns for further appellate review. Entitlement to service connection for a right shoulder disability. While the Board sincerely regrets the additional delay in adjudicating this claim, following a full review of the record, the Board finds that a Remand is necessary in order to obtain an addendum opinion regarding the Veteran's right shoulder disability. In this regard, in April 2021, the Board found that the December 2020 VA opinion was inadequate as it did not address the Veteran's April 2016 statement that her tendonitis in the right shoulder came from "sitting in a office [sic], with all types of cold air, hot air, and etc.," as well as typing for 30 years, and using her right shoulder and arms for everything she did in the Air Force. Moreover, the prior VA opinion noted a September 2018 medical treatment record in which the Veteran reported increased back pain after lifting heavy boxes all day at work. Here, the Board noted that it was unclear how the VA examiner determined the September 2018 reported work injury to the Veteran's back also affected her shoulder. Accordingly, an addendum opinion was obtained in August 2021. The examiner found that the Veteran's allegations are not supported by available medical documentation. The examiner noted that the medical evidence supports the diagnoses of right shoulder (GHJ-injection), cervical radiculopathy, myalgias and trochanteric bursitis of the right hip, and the Veteran is being treated following a worker's compensation claim. The examiner indicated that cold and hot air do not cause disabilities like the ones the Veteran has, injuries do. Rather, the examiner found, the current diagnoses are injuries, which occurred at work, and are quite specific in nature and consistent with clinical and diagnostic work up. The examiner concluded they are not related to what the Veteran alleges, and medical evidence does not support the allegations. The examiner also noted that the Veteran is a smoker, post-menopausal female, and imaging changes are consistent with life-style, age/aging, injuries, nutritional and genetic factors alone, or in combination. Moreover, the examiner indicated that the scientific, medical record, and buddy/lay statements do not rise to the level that is required to opine that the Veteran's current conditions are related to service. However, the August 2021 VA opinion does not address the concerns raised in the prior Board remand. While the examiner acknowledged the Veteran's reports that she was exposed to cold and hot air while working, there was no rationale as to why working in such environments did not contribute to her right shoulder disability. Moreover, the examiner did not address the additional statements of record (that the Veteran typed for 30 years and her work in the Air Force required use of her arms and shoulders, and that such contributed to her current disability). Finally, the August 2021 VA examiner did not address how he concluded that the Veteran's right shoulder disability is related to her reported September 2018 back injury, rather than the documented January 2013 in-service injury. Because of these deficiencies in the August 2021 examination report, the Board finds there has not been substantial compliance with the prior remand directives. Based on the foregoing, the Board finds a remand is necessary in order to obtain an addendum opinion addressing the etiology of the Veteran's right shoulder disability. Stegall v. West, 11 Vet. App. 268 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). This matter is REMANDED for the following action: 1. Forward the record, to include a copy of this remand, to an appropriate clinician to obtain an addendum opinion addressing the etiology of the Veteran's right shoulder disability. The need for an additional examination is at the discretion of the clinician. Following a full review of the record, 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 the Veteran's right shoulder disability is related to her active duty service, to include the documented January 2013 injury to her right shoulder during a period of ACDUTRA. In offering an opinion, the examiner should discuss the Veteran's statements regarding sitting in office with cold and hot air, typing for 30 years, and general use of the arm and shoulder during her time in the Air Force. The examiner is advised that the Veteran is competent to report in-service events and treatment, and the Veteran's symptoms and history, and such reports and assertions must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports, they must provide a reason for doing so. The examiner is also advised that the lack of medical evidence reflecting a continuity of symptomatology cannot be the sole basis of a negative opinion. A rationale for any opinion offered should be provided. 2. After completing the above action, to include any other development as may be indicated by any response received as a consequence of the action taken in the preceding paragraph, the Veteran's claim should be readjudicated based on the entirety of the evidence. A. ADAMSON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Waite 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.