Citation Nr: 22017102 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 19-29 165A DATE: March 24, 2022 REMANDED Entitlement to service connection for a right shoulder disorder is remanded. Entitlement to service connection for sciatica is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 1987 to February 1990. These matters are before the Board of Veterans' Appeal (Board) on appeal from an April 2016 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in November 2021. A copy of the hearing transcript has been associated with the Veteran's file and has been considered in making this decision. A May 2020 rating decision granted the Veteran's claim for service connection for asthma claimed as bronchitis and assigned an initial rating. As this decision represents a full grant of the benefits sought with respect to this claim for service connection, such issue is no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). 1. Entitlement to service connection for a right shoulder disorder is remanded. 2. Entitlement to service connection for sciatica is remanded. The Veteran contends that her right shoulder disorder and sciatica are etiologically related to her active service. Specifically, the Veteran contends that it rifle recoil during rifle training as well as physical training while in-service resulted in her right shoulder disorder. In regard to her sciatica, the Veteran contends that it is the result of running and marching while carrying heavy equipment while in-service. The Veteran was provided VA medical examinations and etiology opinions were obtained for her right shoulder disorder and sciatica in March 2016. A March 2016 VA examiner opined that it was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness as the Veteran reported the onset of shoulder symptoms in 2008 and there is neither documentation of shoulder pain in service nor is there a history of any symptoms until 21 years after enlistment. However, the examiner relied solely on the absence of in-service complaints of a right shoulder disorder as the sole rationale for the negative nexus opinion. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Therefore, the Board finds that a remand is necessary to obtain an adequate medical opinion regarding the nature and etiology of the Veteran's right shoulder disorder. With regards to the Veteran's claimed sciatica, the March 2016 VA examiner opined was less likely than not (less than 50 percent probability) that the Veteran's sciatica was incurred in or caused by the claimed in-service injury, event or illness as the Veteran reported no back injury, symptoms or ongoing pain while in service or after service until 2010. However, the examiner relied solely on the absence of in-service complaints of sciatica as the sole rationale for the negative nexus opinion. See Dalton v. Nicholson, supra. Therefore, the Board finds that a remand is necessary to obtain an adequate medical opinion regarding the nature and etiology of the Veteran's sciatica. For these reasons, the Board finds that remand is necessary. Upon remand, the AOJ should obtain adequate examinations and opinions regarding the etiology of the Veteran's right shoulder disorder and sciatica. Further, the Veteran's representative stated at the Veteran's Board hearing that not all of the Veteran's associated treatment records may have been considered in the VA opinions. The new examiners should ensure to review all records in rendering their opinions. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A (b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain addendum etiology opinions as to the Veteran's right shoulder disorder from appropriate medical professionals. The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. The need for further in-person physical examination is left to the discretion of the examiner. The examiner should respond to the following question: Is it at least as likely as not (50 percent or greater probability) that the Veteran's current right shoulder disorder is related to her service or otherwise due to service? The examiner should specifically address the Veteran's contentions that her right shoulder disorder is the result of refile recoil sustained during weapons training and/or physical training during service. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Following the receipt of outstanding records, obtain addendum etiology opinions as to the Veteran's sciatic from appropriate medical professionals. The record, to include a copy of this Remand, should be made available to the examiner, and all indicated tests should be conducted. The need for further in-person physical examination is left to the discretion of the examiner. The examiner should respond to the following question: Is it at least as likely as not (50 percent or greater probability) that the Veteran's sciatica is related to her service or otherwise due to service? The examiner should specifically address the Veteran's contentions that her sciatica is due to physical training, to include marching, running, crawling and standing during service. A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kashif I. Ali, 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.