Citation Nr: 22047484 Decision Date: 08/22/22 Archive Date: 08/22/22 DOCKET NO. 10-35 273 DATE: August 22, 2022 REMANDED Entitlement to service connection for a right knee condition, claimed as right knee pain, is remanded. Entitlement to service connection for a neck condition, claimed as neck pain, is remanded. Entitlement to service connection for a right shoulder condition, claimed as right shoulder pain, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 2001 to September 2004. His decorations include a Combat Infantry Badge (CIB) for his service in Iraq. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2008 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). Most recently, the matter was remanded in August 2020 and is again before the Board. Unfortunately, remand is again required to ensure compliance with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (explaining the Board is obligated by law to ensure that the RO complies with its directives). In the August 2020 Remand, the Board directed the AOJ to obtain addendum opinions on the etiologies of the claimed right knee, neck, and right shoulder conditions. The remand directives explained that an in-person examination should only be provided if deemed necessary by the clinician(s) providing the addendum opinions. Rather than solicit addendum opinions, the AOJ attempted to schedule the Veteran for examinations in 2020 and 2021 during a period when he was incarcerated and the facility was not allowing examinations due to the novel coronavirus. See December 2020 Report of General Information; see January 2021 Email Correspondence. VA treatment records document the Veteran was released from prison in early June 2022. Those records also document the Veteran had not resumed his mental health medication since release and his family brought him to the emergency room complaining of his bizarre behavior. He refused a recommended in-patient psychiatric hospitalization and failed to report to VA examinations scheduled in June 2022. There is no indication in the record that a clinician determined an in-person examination was required, and the AOJ did not otherwise attempt to obtain addendum opinions. Thus, remand is again necessary to attempt to secure the requested addendum opinions in compliance with the prior remand directives. If a clinician does determine an examination is necessary, VA should undertake necessary efforts to provide the Veteran with the requested examination. In this regard, the Veteran's altered mental status with bizarre behavior in June 2022 may have played a role in his failure to appear for prior examinations. He should be given another opportunity to appear for a VA examination if deemed necessary by the clinician(s) providing the requested opinions. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's right shoulder condition is at least as likely as not related to an in-service, June 2004 motor vehicle accident and/or an IED explosion. An in-person examination is not required unless deemed necessary by the clinician. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's right knee condition is at least as likely as not related to kicking in doors while deployed in Iraq, a June 2004 motor vehicle accident, and/or an IED explosion. An in-person examination is not required unless deemed necessary by the clinician. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's neck condition is at least as likely as not related to kicking in doors while deployed in Iraq, a June 2004 motor vehicle accident, and/or an IED explosion. An in-person examination is not required unless deemed necessary by the clinician. The examiner's attention is invited to June 24, 2004 and July 1, 2004 service treatment records indicating ongoing neck pain from a June 2004 automobile accident. 4. All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. It is not sufficient to base an opinion on a mere lack of documentation of complaints in the service or post-service treatment records. MARTIN B. PETERS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Smith, 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.