Citation Nr: 22040172 Decision Date: 07/13/22 Archive Date: 07/13/22 DOCKET NO. 16-52 977 DATE: July 13, 2022 REMANDED 1. Entitlement to service connection for a neck condition is remanded. 2. Entitlement to service connection for a back condition is remanded. 3. Entitlement to service connection for a left shoulder condition is remanded. 4. Entitlement to service connection for a right shoulder condition is remanded. 5. Entitlement to service connection for erectile dysfunction, as secondary to the back condition, is remanded. 6. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1972 to December 1975. These matters come before the Board of Veterans' Appeals (BVA or Board) on appeal from October 2015 and February 2016 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. In December 2019, the Board issued a decision reopening and denying the above claims. The Veteran appealed this decision to the Court of Appeals for Veterans Claims (Court). By an April 2021 Order, the Court, pursuant to a Joint Motion for Remand (JMR), vacated the Board's December 2019 decision and remanded the case for action consistent with the JMR. In February 2022, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for neck, back, and bilateral shoulder conditions is remanded. At the February 2022 Board hearing, the Veteran attributed the claimed neck, back, and bilateral shoulder disabilities to the physical labor that he performed while stationed on the USS San Diego during service. He described lifting and handling heavy loads on a routine basis, but stated that he did not seek treatment for these conditions due to the general nature of his aches and pains, and being discouraged from doing so by the medical staff aboard the ship. The Veteran also reported involvement in a physical altercation and being thrown across the ship during a storm, which he contended contributed to his regular neck, back, and shoulder pain. The record reflects that the Veteran has been diagnosed to have degenerative disc disease of the lumbar and cervical spine. See Treatment Record dated October 8, 2009. Additionally, the Veteran has been diagnosed with chronic impingement syndrome, bursitis, a rotator cuff tear, and arthritis of the acromioclavicular joint of the right shoulder, as well as a rotator cuff tear of the left shoulder. See Treatment Records dated December 3, 2008 and January 21, 2010. The Board notes that the Veteran sought treatment for his bilateral shoulder disability as early as February 2003. In June 2008, he was injured while lifting heavy panels at work. The Veteran underwent surgery for his right shoulder in December 2008, as well as surgery for his left shoulder in July 2009. In a September 2015 private medical opinion, Dr. J.W.E. traced the claimed neck, back, and shoulder disabilities to the Veteran's job duties during military service. The Board finds that the evidence of record triggers the duty to assist and provide the Veteran with VA examinations for the claimed conditions. 2. Entitlement to service connection for erectile dysfunction, as secondary to the back condition, is remanded. Because a decision on the remanded issue of service connection for a back condition will significantly impact a decision on the issue of service connection for erectile dysfunction, the issues are inextricably intertwined. As such, a remand of this claim is required pending the development of the back condition claim. 3. Entitlement to a TDIU is remanded. The Veteran's entitlement to a TDIU is inextricably intertwined with the pending service connection claims on appeal that have been remanded. As such, the outcome of this remand may have an impact on the claim for entitlement to a TDIU. Therefore, the Board finds that the claim for TDIU benefits must be remanded as well. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (issues are inextricably intertwined when a decision on one issue would have a significant impact on another issue). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all relevant VA and non-VA health care providers, other than those already associated with the claims file, and authorize VA to obtain non-VA records. Updated VA treatment records should also be obtained. 2. The Veteran should be afforded a VA examination for the purpose of determining the nature and etiology of his neck condition. The claims file must be made available to the examiner for review in connection with the examination. Following a review of the relevant evidence, to include the claims file, service treatment records, post-service treatment records; a history obtained from the Veteran, the clinical evaluation, and any tests that are deemed necessary, the examiner should determine: Whether the neck condition began during service or is causally related to service, to include the Veteran's job duties, the reported physical altercation, and when the ship rolled. The examiner should also explain the role, if any, of the Veteran's post-service job duties and job injury in June 2008. The examiner is advised that an absence of documentation in the Veteran's service treatment records cannot serve as the sole basis for a negative opinion. The examiner should specifically indicate the reasons and bases for the conclusions expressed and must address the September 2015 private medical opinion, as well as the Veteran's statements regarding his in-service injuries, and post service complaints. For the purposes of this examination, such statements are to be accepted as credible If the examiner is unable to offer the requested opinions, that person should offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. The Veteran should be afforded a VA examination for the purpose of determining the nature and etiology of his back condition. The claims file must be made available to the examiner for review in connection with the examination. Following a review of the relevant evidence, to include the claims file, service treatment records, post-service treatment records; a history obtained from the Veteran, the clinical evaluation, and any tests that are deemed necessary, the examiner should determine: Whether the back condition began during service or is causally related to service, to include the Veteran's job duties, the reported physical altercation, and when the ship rolled. The examiner should also explain the role, if any, of the Veteran's post-service job duties and job injury in June 2008. If, and only if, a positive nexus opinion is provided for the Veteran's back condition, then obtain an opinion as to: (a) Whether the diagnosed erectile dysfunction, is either proximately due to OR aggravated by a service-connected disability. (b) If the examiner finds that the Veteran's erectile dysfunction has been aggravated by a service-connected disability, the examiner should state the baseline level of severity of the erectile dysfunction, established by the earliest available medical evidence, and describe the extent to which the condition was worsened by any service-connected disability. The examiner is advised that an absence of documentation in the Veteran's service treatment records cannot serve as the sole basis for a negative opinion. The examiner should specifically indicate the reasons and bases for the conclusions expressed and must address the September 2015 private medical opinion, as well as the Veteran's statements regarding his in-service injuries and post service complaints. For the purposes of this examination, such statements are to be accepted as credible. If the examiner is unable to offer the requested opinions, that person should offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. The Veteran should be afforded a VA examination for the purpose of determining the nature and etiology of his bilateral shoulder condition. The claims file must be made available to the examiner for review in connection with the examination. Following a review of the relevant evidence, to include the claims file, service treatment records, post-service treatment records; a history obtained from the Veteran, the clinical evaluation, and any tests that are deemed necessary, the examiner should determine: Whether the bilateral shoulder condition began during service or is causally related to service, to include the Veteran's job duties, the reported physical altercation, and when the ship rolled. The examiner should also explain the role, if any, of the Veteran's post-service job duties and job injury in June 2008. The examiner is advised that an absence of documentation in the Veteran's service treatment records cannot serve as the sole basis for a negative opinion. The examiner should specifically indicate the reasons and bases for the conclusions expressed and must address the September 2015 private medical opinion, the February 2003 post-service shoulder treatment, as well as the Veteran's statements regarding his in-service injuries and post service complaints. For the purposes of this examination, such statements are to be accepted as credible. (Continued on the next page) If the examiner is unable to offer the requested opinions, that person should offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Erin J. Trojanowski, 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.