Citation Nr: 22031345 Decision Date: 05/26/22 Archive Date: 05/26/22 DOCKET NO. 10-08 935 DATE: May 26, 2022 REMANDED Entitlement to service connection for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Air Force from February 1981 to September 1991. The Veteran died in January 2020. The appellant is the Veteran's daughter and has been substituted for the deceased Veteran. This matter is on appeal to the Board of Veterans' Appeals (the Board) from a June 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran initially requested a videoconference hearing in conjunction with his appeal, but in September 2015 withdrew his request. The Veteran filed to reopen his claim for service connection for a left shoulder disorder in March 2009, which was denied in a June 2009 rating decision. In February 2016, the Board reopened the Veteran's claim for service connection for a left shoulder disorder, and remanded the case for further development and adjudication on the merits. In October 2017 the Board again remanded the issue for additional development. In April 2019 the Board denied entitlement to service connection for a left shoulder disability. The Veteran subsequently appealed the April 2019 Board decision to the United States Court of Appeals for Veterans Claims (the Court). In a December 2020 order, the Court granted the parties' Joint Motion for Remand (JMR), vacating the Boards' April 2019 decision regarding the denial of entitlement to service connection for a left shoulder disability, and remanded the appeal to the Board for readjudication consistent with the JMR. In April 2021 the Board remanded this issue for additional development. The Board finds that more development is necessary prior to final adjudication of the claim on appeal. The appellant contends that the Veteran's left shoulder disability was related to service to include as secondary to his service-connected right shoulder disability. The Board initially notes that the Veteran is already service connected for service-connected for degenerative joint disease and degenerative disc disease of the cervical spine and the resultant radiculopathy, stemming from the service-connected cervical degenerative disc disease, in both upper extremities. All 3 of these disabilities (cervical spine, radiculopathy of the left upper extremity, radiculopathy of the right upper extremity) are independently assigned disability evaluations. As a result, the Veteran would not be entitled to service connection for left shoulder pain as a manifestation of his service-connected radiculopathy of the left upper extremity. However, this does not rule out the possibility that he had other pathology of the left shoulder, for which service connection could be granted. The Veteran notably underwent a VA examination in February 2018. The examiner opined that it was less likely than not that the Veteran's claimed left shoulder AC joint arthritis disability was related to his right shoulder disability. The examiner noted that although the Veteran believed the left shoulder is secondary to the right shoulder, "this is unfounded" as a search of the literature failed to substantiate arthritis of the contralateral shoulder due to the primary arthritis shoulder joint. However, the examiner did not address whether the Veteran's service-connected right shoulder disability had aggravated his left shoulder disability. As such the Board finds that the evidence currently of record is insufficient to resolve the claims for a left shoulder disability and that further medical clarification in connection with this claim is warranted to determine whether the Veteran's left shoulder disability was caused or aggravated by a service-connected disability. The Board again notes that service connection is not in effect for a right shoulder disability, other than the radiculopathy of the right upper extremity which is due to the service-connected cervical spine disability. Additionally, the February 2018 VA examiner also indicated that while within the realm of medical possibility, it appears less likely than not that the Veteran's fibromyalgia was related to his military service and more likely than not associated with the stress of his wife's death after a long and painful illness, his reactive depression that ensued, and his inactivity as he was caring for his wife. Notably, while the February 2018 VA medical opinion found that the fibromyalgia was more likely than not associated with postservice factors stemming from circumstances surrounding his wife's prolonged illness and death, the examiner again noted that one of the circumstances was "reactive depression". The Board notes that the Veteran is service-connected for major depressive disorder associated with his thoracolumbar spine disability. As a result, the Board finds that further medical clarification in connection with this claim is also warranted to determine whether the Veteran's left shoulder disability was caused or aggravated by a service-connected disability to include his service-connected major depressive disorder disability. Thus, the Board finds that the evidence currently of record is insufficient to resolve the claim for entitlement to service connection for a left shoulder disability and that further opinions in connection with this claim are necessary for a fully informed evaluation of the claim on appeal. Green v. Derwinski, 1 Vet. App. 121, 124 (1991); 38 C.F.R. § 3.159(c) (4). As a result, the Board finds that a VA medical opinion is required to address whether the Veteran had a left shoulder disability, independent of his service-connected radiculopathy of the left upper extremity disability, that was related to his active-duty service to include as to whether it was caused or aggravated by his service-connected disabilities. The matters are REMANDED for the following action: 1. The appellant should be requested to provide the names, addresses and approximate dates of treatment of all medical care providers, VA and non-VA, who treated the Veteran for the disability on appeal. After the appellant has signed the appropriate releases, those records should be obtained and associated with the claims folder. 2. After the above development has been completed, and after any records obtained have been associated with the evidentiary record, obtain a medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's left shoulder disability, independent of his service-connected radiculopathy of the left upper extremity disability. Based on a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left shoulder disability (independent of his service-connected radiculopathy of the left upper extremity disability) was related to any incident of the Veteran's active duty service. The examiner should also provide an opinion as to whether if it is at least as likely as not (at least a 50 percent probability) that any such left shoulder disability was caused or aggravated by his service-connected acquired psychiatric disorder, right shoulder and cervical spine disabilities. If the examiner finds that the Veteran had a left shoulder disability that had been permanently aggravated/worsened by his service-connected acquired psychiatric disorder, right shoulder or cervical spine to the extent feasible, the degree of worsening should be identified. All opinions expressed by the examiner must be accompanied by a complete rationale. Adequate reasons and bases for any opinion rendered must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail. 3. Thereafter, readjudicate the issue on appeal. If any benefit sought on appeal remains denied, the appellant and her representative should be provided with a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board James A. DeFrank, 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.