Citation Nr: 22016623 Decision Date: 03/22/22 Archive Date: 03/22/22 DOCKET NO. 10-01 319 DATE: March 22, 2022 REMANDED Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1986 to June 1990, with subsequent service in the National Guard during the period 1994 to 1996. This matter comes before the Board of Veterans Appeals (Board) on appeal of a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) and Board remands in April 2012, July 2015, September 2016, May 2018, August 2019, and February 2021. The Board notes that this appeal has been subject to multiple remands for VA opinions and clarifications; this remand is warranted, at least in part, due to a recent assertion of secondary service connection. See Appellate Brief (December 2021). Remand is required to obtain an adequate VA examination and opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Here, each of the VA examiners note that the Veteran's left shoulder disorder existed prior to service. See C&P Exam (March 2019); C&P Exam (June 2021). But the entrance examination was silent and the other evidence of record does not support a finding that clear and unmistakable evidence shows that there was a prior left shoulder disability. See 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b); VAOPGCPREC 3-03, 69 Fed. Reg. 25178 (2004); Wagner v. Principi, 370 F.3d 1089, 1093 (Fed. Cir. 2004). Accordingly, remand is required for etiological opinions that presume the Veteran sound upon entry. Additionally, the Veteran's representative asserted that secondary service connection should also be considered. See Appellate Brief (December 2021). The Veteran is now service connected for his right shoulder disability. See Rating Decision Codesheet (November 2021). A nexus opinion that considers whether his left shoulder disability is related to or aggravated by his right shoulder disability is thus necessary. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of each left shoulder disorder from a VA clinician. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. First, the clinician must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that each diagnosed left shoulder disorder had onset in, or is otherwise related to, active service, including his reported in-service fall from his bunk bed. Second, the clinician must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that each left shoulder disorder is caused or aggravated by the service-connected right shoulder disability, to include as due to increased wear and tear on the left shoulder. The clinician should specifically address the websites linked in the December 2021 brief. The clinician should address the following: (a) the service treatment records noting chronic shoulder dysfunction due to calcium deposits, probably supraspinatus tendonitis, possible bursitis, and normal x-rays; (b) October 1992 and September 1994 examinations in which the Veteran denied arthritis, rheumatism, bursitis, and a painful or "trick" shoulder, and clinical evaluation of the upper extremities and musculoskeletal system was normal; (c) 1995 private records that noted bilateral shoulder impingement; (d) March 2003 private records that indicated normal x-rays and a clinical impression of left shoulder strain; (e) VA examinations dated in 2012 and 2021, and (f) lay statements in which the Veteran reported he injured his shoulders in service when he fell off a bunk, and that he has shoulder symptoms since that time. For the purposes of this remand only, the examiner should assume that the Veteran's lay assertions concerning his left shoulder pain in service and subsequent issues are true. If there is a medical reason to doubt its veracity, the examiner should explain why the Veteran's recollection is inconsistent with the principles of medical science and/or the evidence in this case. 2. Ensure compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures. Stegall v. West, 11 Vet. App. 268, 271 (1998). K. MILLIKAN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Brunot, 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.