Citation Nr: 22017851 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 19-10 071 DATE: March 26, 2022 REMANDED The claim for service connection for a right shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1984 to June 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2019, the Board denied the Veteran's claim to reopen service connection for a right shoulder disability. The Veteran appealed that decision to the Court of Appeals for Veterans Claims (Court). In August 2020, the Court granted a Joint Motion for Remand (Joint Motion), vacating the Board's September 2019 decision and remanding it to the Board for readjudication. The Board then remanded the claim in January 2021 and June 2021. In October 2021, the Board reopened the claim and again remanded it for further development. The requested development was completed, and the case has been returned to the Board for further appellate action. 1. The claim for service connection for a right shoulder disability is remanded. The Veteran asserts that a current right shoulder disability was caused or aggravated by his service-connected left and/or right knee disabilities. Specifically, he has asserted that he injured his right shoulder when his left knee gave out while walking down the stairs of his recreational vehicle (RV). Private treatment records show that the Veteran initially injured his right shoulder in a motor vehicle accident in September 1998. An MRI revealed a complex right rotator cuff tear, right shoulder impingement syndrome, right acromioclavicular (AC) joint arthropathy, a possible anterior glenoid labral tear, and early degenerative changes of the AC joint. In October 1998, the Veteran underwent a right rotator cuff repair, arthroscopic subacromial decompression, arthroscopic resection of the distal clavicle, and arthroscopic repair of the glenoid labral tear. Four months after the surgery, the Veteran reported being pain free and doing extremely well. A July 2013 VA treatment record shows that the Veteran reported falling three weeks earlier with trauma to the left knee, which popped out and was put back into place without medical treatment. In August 2013, the Veteran reported symptoms of right shoulder arthralgia. In January 2014, he reported falling off the steps of his motor home and hurting his left knee and right shoulder. In May 2014, the Veteran reported falling about six to eight months earlier when he slipped and fell on steps. He stated that he hit his right shoulder when his left knee hyperflexed. The Veteran underwent a VA examination in December 2014, during which he reported injuring his right shoulder around May 2013 when his knees gave way. The examiner opined that it was less likely than not that a current right shoulder disability was caused by the Veteran's service-connected knee disabilities because there was "no medical record of this injury to confirm." Subsequent treatment records show that the Veteran reported worsening right shoulder pain, and he eventually underwent a right reverse shoulder arthroplasty in March 2017. The Veteran underwent another VA examination in December 2021, during which he reported injuring his right shoulder in a fall when his left knee gave out, causing his right shoulder to hit a handrail. The examiner opined that it was less likely than not that a current right shoulder disability was caused by the Veteran's service-connected knee disabilities because the Veteran had an extensive history of right shoulder complaints, and although treatment records show that he fell and hurt his right shoulder, there was no confirmed account for the cause of the fall besides a subjective report by the Veteran in March 2016. The examiner further noted that degenerative hypertrophy changes noted on a March 2017 x-ray were a cumulative process given the extensive history of the Veteran's right shoulder complaints. In January 2022, the same examiner opined that it was less likely than not that a current right shoulder disability was aggravated by the Veteran's service-connected knee disabilities because "[t]here is no evidence to indicate the Veteran's right shoulder conditions continued to be aggravated (increased in severity beyond the natural progress of the condition) by the Veteran's service-connected knee disabilities including bilateral knee total knee replacement." The Board finds that a new VA medical opinion should be obtained because the December 2021 VA examiner did not provide an adequate rationale to support the opinion that the Veteran's preexisting right shoulder conditions were not aggravated by the 2013 fall, which the Veteran claims was caused by his service-connected left knee disability. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Additionally, in rendering an opinion addressing secondary causation, the examiner relied in large part on the fact that there was no confirmed account for the cause of the fall besides a subjective report by the Veteran in March 2016. However, treatment records show that the Veteran reported on several occasions in 2013 and 2014 that the fall was caused by his left knee disability. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that "[a]n opinion based on an inaccurate factual premise has no probative value"). Moreover, in a February 2022 rating decision, service connection was granted for a sacroiliac (SI) joint injury secondary to the Veteran's service-connected left knee replacement based on the Veteran's assertion that the injury to his SI joint was sustained in the same 2013 fall down the stairs of his RV. Thus, the RO has essentially conceded that the 2013 fall down the stairs of the Veteran's RV was caused by his service-connected left knee disability. The Veteran is advised that the Board has not made a final determination as to whether the 2013 fall was caused by his service-connected knee disabilities. However, for purposes of obtaining a new medical opinion, the examiner should assume that the 2013 fall was caused by the Veteran's service-connected left knee disability unless the examiner has reason to doubt the credibility of the Veteran's assertion in that regard. The matter is REMANDED for the following action: Obtain a medical opinion pursuant to the Veteran's claim for service connection for a right shoulder disability. Do not schedule the Veteran for another examination unless it is deemed necessary by the examiner to respond to the questions presented. After review of the claims file, the examiner should answer the following: (a.) Is it at least as likely as not (50 percent probability or greater) that a current right shoulder disability was caused by the Veteran's service-connected left and/or right knee disability, to include as due to the 2013 fall down the stairs of the Veteran's RV? Please explain why or why not. (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's preexisting degenerative changes of the right AC joint, status post right rotator cuff repair, was aggravated by the Veteran's service-connected left and/or right knee disability, to include as due to the 2013 fall down the stairs of the Veteran's RV? Please explain why or why not. For purposes of rendering the requested opinions, the examiner may assume that the 2013 fall down the stairs of the Veteran's RV was caused by his service-connected left knee disability. If the examiner has reason to doubt the credibility of the Veteran's assertion that the 2013 fall was caused by his service-connected left knee disability, the examiner must provide a complete rationale for that opinion. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Banister, 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.