Citation Nr: 22048780 Decision Date: 08/26/22 Archive Date: 08/26/22 DOCKET NO. 18-51 822 DATE: August 26, 2022 REMANDED Entitlement to service connection for cervical spine disability is remanded. Entitlement to service connection for right shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 2003 to April 2003. These matters come to the Board of Veterans' Appeals (Board) on appeal of a November 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for cervical condition and right shoulder condition. The Veteran testified before the undersigned Veterans Law Judge during a hearing in December 2021. A transcript of the hearing is in the claims file. 1. Entitlement to service connection for cervical spine disability is remanded. 2. Entitlement to service connection for right shoulder disability is remanded. The Veteran contends that his cervical spine disability and right shoulder disability are secondary to his service-connected right wrist disability. Specifically, he asserts that the in-service injury to his right wrist caused blood flow issues, which resulted in poor circulation to the rest of his right arm and led to the development of his current neck and right shoulder disabilities. See December 2021 Board hearing testimony (pp. 5-7). During a June 2016 VA examination for shoulder and arm conditions, the Veteran was diagnosed with degenerative arthritis of the right shoulder and partial rotator cuff tear (RCT) with bursitis of the right shoulder. The examiner stated that he could not comment as to whether the diagnosed disabilities of the right shoulder were secondary to his right wrist disability without resorting to mere speculation. The examiner provided no rationale for this conclusion, which renders it inadequate. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). A VA examination conducted in July 2017 diagnosed the Veteran as having complex regional pain syndrome. An addendum to this examination was obtained in December 2017 wherein it was determined that the Veteran's complex regional pain syndrome (RSD) was a progression of his service connected right wrist disability. Such resulted in the eventual award of service connection for reflex sympathetic dystrophy complex regional pain syndrome (RSD/CRPS). Problematically, the December 2017 addendum failed to clearly address the Veteran's diagnosed right shoulder arthritis and partial RCT. The opinion only vaguely referred to the right shoulder region in addressing the pain he experienced from his RSD. The addendum did not cure defect of the June 2016 opinion. During a January 2018 VA examination for cervical spine conditions, the Veteran was diagnosed with cervical spondylitis with myelopathy and complex regional pain syndrome of the neck. The examiner provided a negative nexus opinion, noting that the Veteran did not have any complaints of neck condition while in service, and that his current neck diagnoses were not connected to his service-connected right wrist disability. However, the examiner did not provide rationale to support these conclusions. In March 2022, the Veteran submitted a nexus opinion from Dr. R.W., a private orthopedist hand surgeon, who treated the Veteran for right wrist conditions seven years earlier. Dr. R.W. stated that he could not address or speak in regard to the Veteran's cervical spondylitis with myelopathy and degenerative arthritis with partial rotator cuff tear and bursitis of the right shoulder "as these are out of the scope of [his] practice." As such, the Board finds this opinion to also be inadequate for adjudication purposes. Because the medical examinations and opinions did not adequately address the Veteran's claims for service connection for his right shoulder and cervical spine disabilities, remand is necessary to fulfill VA's duty to assist. 38 U.S.C. § 5103A; Stefl v. Nicholson, 21 Vet. App. 120 (2007). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. After the above development has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of any cervical spine disability. After reviewing the Veteran's claims file and examining the Veteran, the examiner should opine on the following: a. Identify/diagnose any cervical spine condition that presently exists or that has existed during the appeal period. If no diagnosis is made, an explanation must be provided that addresses diagnoses previously made, e.g. cervical spondylitis with myelopathy and complex regional pain syndrome of the neck, which were diagnosed in a January 2018 VA examination. b. For any diagnosed cervical spine disabilities, stated whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that: i. the condition is proximately due to a service-connected right wrist disability and associated RSD/CRPS. ii. the condition underwent any incremental increase in disability, regardless of its permanence, due to his service-connected right wrist disability and associated RSD/CRPS. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. A full rationale must be provided for any opinion offered and a thorough explanation would be helpful for the Board. Reference to findings from identified studies is preferred over reference to medical literature in the abstract. If the examiner relies on his or her medical experience as a rationale, it is appropriate to identify the specifics such as an estimate of the number of patients the examiner has seen with similar conditions, the time the examiner had been practicing in the field, or any relevant specialized education or training experiences that go beyond the examiner's degree or accreditation. 3. After the first directive has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of any right shoulder disability. After reviewing the Veteran's claims file and examining the Veteran, the examiner should opine on the following: a. Identify/diagnose any right shoulder condition that presently exists or that has existed during the appeal period. If no diagnosis is made, an explanation must be provided that addresses diagnoses previously made, e.g., degenerative arthritis of the right shoulder and partial rotator cuff tear with bursitis of the right shoulder, which were diagnosed in a June 2016 VA examination. b. For any diagnosed right shoulder disabilities, stated whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that: i. the condition is proximately due to his service-connected right wrist disability and associated RSD/CRPS. ii. the condition underwent any incremental increase in disability, regardless of its permanence, due to his service-connected right wrist disability and associated RSD/CRPS. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. A full rationale must be provided for any opinion offered and a thorough explanation would be helpful for the Board. Reference to findings from identified studies is preferred over reference to medical literature in the abstract. If the examiner relies on his or her medical experience as a rationale, it is appropriate to identify the specifics such as an estimate of the number of patients the examiner has seen with similar conditions, the time the examiner had been practicing in the field, or any relevant specialized education or training experiences that go beyond the examiner's degree or accreditation. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fairlie, 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.