Citation Nr: 22019697 Decision Date: 04/02/22 Archive Date: 04/02/22 DOCKET NO. 14-19 870 DATE: April 2, 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 low back disability is remanded. Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for a lung disability is remanded. Entitlement to service connection for a brain disorder (including multifocal small white matter lesions consistent with demyelination or small vessel ischemic changes or involving memory loss) is remanded. REASONS FOR REMAND The veteran served on active duty in the United States Coast Guard from September 1970 to September 1974. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing held via videoconferencing equipment before the undersigned Veterans Law Judge in May 2015. A copy of the transcript of that hearing is of record. Addressing the relevant procedural history, these six claims were previously before the Board in April of 2020 at which time the Board respectively denied them. The appellant appealed the Board's decision to the Court of Appeals for Veterans Claims (the Court). In December of 2021, the Court granted a Joint Motion for Partial Remand (JMPR) signed by both parties and remanded the claim to the Board for action consistent with the terms of the JMPR. Entitlement to service connection for a right shoulder disability, service connection for a left shoulder disability, service connection for a low back disability, service connection for sinusitis, service connection for a lung disability, and service connection for a brain disorder (including multifocal small white matter lesions consistent with demyelination or small vessel ischemic changes or involving memory loss) is remanded. In December 2015, the Board remanded the claim, in part to attempt to obtain relevant treatment records from the Seaside Hospital (now renamed Sutter Coast Hospital). On March 16, 2016, the RO wrote to the Veteran and requested that he complete a Form 21-4142 (Authorization to Disclose Information) and VA Form 21-4142a (General Release for Medical Provider Information in order to allow the RO to assist in obtaining those records. The Veteran did not respond by providing the requested authorization forms. The RO then made a second request to the Veteran later on March 30, 2016. Again, he did not respond. In a supplemental statement of the case issued in August 2016, the RO noted the previous requests for authorization forms and stated that "As to date, we haven't received any response from you since the initial contact." In March 2017, the Veteran's representative requested that the case be returned to the Board. In April 2020, the Board issued a decision denying the claim. In the JMPR, it was stated that "the evidence of record does not show that any records from Sutter Coast Hospital have been obtained or that any attempts to obtain records from that facility have been made by VA." It was stipulated in the JMPR that, "On remand, the Board shall remand Appellant's claims to the RO so that the RO can solicit and obtain a consent form for the release of records from Appellant. Once that information is obtained, and in compliance with the Board's previous December 2015 directive, the RO shall then attempt to obtain any outstanding records from Sutter Coast Hospital. All efforts made by the RO must be documented and associated with Appellant's VA file, to include any formal finding that the records cannot be obtained or that any further efforts to obtain the records would be futile. However, if on remand, additional records are obtained, VA shall then determine whether further development, in the form of a new VA examination and/or opinion, is warranted in this case." The Board is bound by the foregoing JMPR which mandates that VA make additional efforts to obtain any outstanding private treatment records (including those from Sutter Coast Hospital). Thereafter, if the record is expanded, a new opinion should be authored on remand by a VA examiner that adequately considers the evidence of record, including any additional treatment records and/or any other evidence submitted by the appellant on remand, and who also administers examinations as necessary. The matters are REMANDED for the following actions: 1. Contact the Veteran and afford him another opportunity to identify by name, address and dates of treatment any outstanding private treatment providers, to include those from Seaside/Sutter Coast Hospital. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice (including a formal finding) and opportunity to respond to the Veteran and his representative. 2. If and only if additional records are obtained or other evidence is associated with the claims file on remand, obtain an addendum opinion from an appropriate medical professional after administering VA examinations as is appropriate and conducting all necessary tests and studies. Each medical professional must be provided with and review the entire claims file, to include a copy of this remand, and it should be confirmed that such was reviewed. Following a review of the evidence of record, to include the Veteran's lay statements, each clinician is requested to provide an opinion as to whether any new evidence alters prior 2016 opinions, and if so, identify how. Only if this cannot be answered, then entirely new opinions should be obtained regarding whether it is at least as likely as not (50 percent probability or higher) that each respective condition began in or was etiologically related to his active duty service. (Continued on the next page) An explanation must be provided for all conclusions reached. As part of his or her rationale, the medical professional is specifically asked to address, and reconcile to the extent possible, lay assertions made by the Veteran as well as any conflicting medical evidence or opinions of record. 3. Thereafter, readjudicate the claims on appeal. If the benefits sought remains denied, issue the Veteran and his representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning this matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Smith, 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.