Citation Nr: 22016985 Decision Date: 03/23/22 Archive Date: 03/23/22 DOCKET NO. 16-20 066 DATE: March 23, 2022 REMANDED Entitlement to service connection for arthritis of the left shoulder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from December 1976 to December 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified at a Board hearing before the undersigned Veteran's Law Judge. The transcript of the proceeding is of record. In October 2019 and July 2021, the Board remanded the case for additional development, which has not been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for arthritis of the left shoulder is remanded. The Board regrets the additional delay; however, a remand is necessary to ensure compliance with the Board's prior remand instructions and to ensure that due process is met. Stegall v. West,11 Vet. App. 268, 271(1998). Once VA undertakes the effort to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In November 2021, the Veteran attended a VA examination for his left shoulder condition. See November 2021 VA Examination. The examiner noted that the Veteran has a diagnosis of acromioclavicular joint osteoarthritis, rotator cuff tendonitis, and bicipital tendonitis. The Veteran reported his left shoulder pain stems from an in-service motor vehicle accident that occurred in May 1977. The Veteran's service treatment records indicate that the Veteran sought treatment for a left shoulder sprain in September 1978, with a notation that he sustained the injury the prior evening. The examiner opined that given the time between the motor vehicle accident and the sprain, the Veteran's shoulder pain could not have been caused by the motor vehicle accident. The examiner also indicated that, while the Veteran testified that he has received ongoing treatment for his left shoulder, the Veteran's post-service treatment records indicate that he did not seek medical treatment for his left shoulder until approximately 2018. As the examiner found that the claims file did not include evidence of complaints, diagnosis or treatment for left rotator cuff tendonitis, left bicipital tendonitis, and left acromioclavicular joint osteoarthritis during active military service, the examiner found that the Veteran's conditions were not caused by his active military service. The examiner also opined that the Veteran's left shoulder injury is less likely than not proximately due to or the result of the Veteran's right shoulder injury. The examiner noted that arthritis in one joint does not cause arthritis in another joint. Additionally, the Veteran was diagnosed with right shoulder osteoarthritis in 2001 and was not diagnosed with left shoulder osteoarthritis until 2014. The Board finds the opinion is insufficient for adjudication as it does not provide an adequate rationale. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The examiner failed to consider and discuss whether the Veteran's September 1978 shoulder sprain could have caused or aggravated the Veteran's diagnosis of acromioclavicular joint osteoarthritis, rotator cuff tendonitis, and bicipital tendonitis of the left shoulder. The examiner did not provide a medical basis to support or doubt the medical history provided by the Veteran of having continuous symptoms since active duty as directed by the remand. Instead, it appears the examiner was making a credibility determination as to the Veteran's self-reported medical history. The examiner noted the Veteran's report that he started using his left shoulder more due to problems with his service connected right shoulder disability. This suggests a possibility that service connection is warranted on a secondary basis and an opinion addressing this should be obtained. As the examiner failed to appropriately address and consider the Veteran's in-service diagnosis of shoulder sprain, along with the Veteran's testimony that his injury began during service and continued ever since, and relied on the absence of evidence without explaining the significance of such, a remand is necessary to obtain an addendum medical opinion. The matter is REMANDED for the following action: 1. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. 2. Obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran's claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination, if necessary, the examiner must address the following: (a.) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's left shoulder disorder is related to his active service or is caused by or aggravated by military service. (b.) Whether it is at least as likely as not that the left shoulder disorder was caused or aggravated by the service connected right shoulder disability. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. The term "aggravation" means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. In all opinions rendered, the examiner is advised that the Veteran is competent to report his symptoms and treatment history. The examiner must specifically consider and discuss the Veteran's testimony regarding his in-service injury of a motor vehicle accident and continuity of symptomology since service. The opinion and rationale should reflect such consideration. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Schmidt 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.