Citation Nr: 22017879 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 17-22 008 DATE: March 26, 2022 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right elbow disability is remanded. Entitlement to service connection for a left elbow disability is remanded. Entitlement to service connection for a right wrist disability is remanded. Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for a right hand disability is remanded. Entitlement to service connection for a left hand disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1972 to April 1974. These matters are before the Board of Veterans' Appeals (Board) on appeal from a February 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The issues on appeal were previously before the Board in October 2021, when they were remanded to the agency of original jurisdiction (AOJ) for additional development. Unfortunately, the Board is not satisfied that there was substantial compliance with its prior remand instructions; therefore, the appeal must be remanded once again. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for a right shoulder disability is remanded. 2. Entitlement to service connection for a left shoulder disability is remanded. 3. Entitlement to service connection for a right elbow disability is remanded. 4. Entitlement to service connection for a left elbow disability is remanded. 5. Entitlement to service connection for a right wrist disability is remanded. 6. Entitlement to service connection for a left wrist disability is remanded. 7. Entitlement to service connection for a right hand disability is remanded. 8. Entitlement to service connection for a left hand disability is remanded. The Veteran seeks entitlement to service connection for bilateral shoulder, elbow, wrist, and hand disabilities, which he contends are due to his military occupational specialty (MOS) duties as a Boatswain's Mate during Navy service. In an October 2020 statement, he described the nature of his duties, such as chipping paint off the side of the ships and pulling cables between ships, which required a lot of physical labor and repetitive movements with his upper extremities. See October 2020 statement. Pursuant to the October 2021 remand, addendum medical opinions were obtained in December 2021. In separate opinions addressing each claimed disability, a VA examiner provided identical, but unfavorable, nexus opinions based upon finding that there are no records of complaints, exam, or diagnosis related to the shoulders, elbows, wrists, or hands during service or within one year of separation. However, upon examination, the Veteran reported to the examiner that his bilateral shoulder, elbow, wrist, and hand pain arose in 1974 due to the repetitive movement of pulling cable on old ships during his Navy service. The examiner does not appear to have considered the Veteran's reports of experiencing an in-service onset of pain due to his military duties and, instead, based his negative opinions solely on an absence of documented treatment in the service treatment records. Such an opinion is insufficient to deny service connection and is therefore inadequate. See generally Dalton v. Nicholson, 21 Vet. App. 23 (2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006). In light of the above, the Board finds that the record still does not contain medical opinions that are adequate to allow the Board to fairly adjudicate the Veteran's service connection claims. As such, the claims must be remanded once again because the RO did not comply with the Board's prior remand directives to obtain adequate medical opinions on the Veteran's behalf. See Stegall, 11 Vet. App. at 271. On remand, addendum medical opinions must be obtained from a qualified VA examiner that are adequate for the Board to make an informed decision on the Veteran's claims. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007); Douglas v. Shinseki, 23 Vet. App. 19, 26 (2009). Accordingly, the matters are REMANDED for the following action: Obtain addendum medical opinions from an appropriate VA examiner (M.D.) addressing whether the Veteran's bilateral shoulder, elbow, wrist, and hand conditions are at least as likely as not related to his military service. The examiner must specifically address the Veteran's lay contentions as to experiencing an in-service onset of pain due to his MOS duties, as well as his post-service symptoms such as recurrent pain since service discharge. The examiner is advised that the Veteran is competent to report his medical history, including the onset of symptoms, and such reports must be acknowledged, considered, and weighed in formulating any opinion. The examiner must provide a complete rationale for any opinion offered, citing to the examiner's own expertise, medical principals, and/or evidence in the Veteran's claims file, when necessary, to support the conclusion reached. If the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts), or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). The examiner is reminded that failure to comply with the examination directives outlined herein will render the opinion inadequate and will result in further remand of the Veteran's claims. Melissa Barbee Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, 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.