Citation Nr: 23009261 Decision Date: 02/14/23 Archive Date: 02/14/23 DOCKET NO. 18-34 876 DATE: February 14, 2023 REMANDED Entitlement to service connection for a shoulder disability, secondary to service-connected bilateral varicose veins disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from November 1968 to April 1972. This case comes on appeal of a September 2014 rating decision. The Veteran testified before the Board at a December 2021 virtual hearing. A transcript of that hearing is of record. In a May 2022 decision, the Board evaluated the severity of the Veteran's bilateral varicose veins condition. As part of the duty to maximize benefits, the Board observed that the Veteran had raised the issue of service connection for a shoulder disability, secondary to falls the Veteran claimed were caused by the varicose veins disabilities. Accordingly, the Board remanded that issue for further development. Unfortunately, additional remand is necessary to afford the Veteran due process. 1. Entitlement to service connection for a shoulder disability, secondary to service-connected bilateral varicose veins disabilities is remanded. Whenever VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). An adequate medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Here, VA obtained a medical opinion to address the etiology of the Veteran's shoulder disability in November 2022. The examiner who provided the opinion concluded that it was less likely than not that the Veteran's shoulder disability was caused or aggravated by varicose veins. The examiner provided several reasons as to why the Veteran's varicose veins, and associated neuropathies, would not cause the Veteran to fall. Included in that reasoning was the assertion that the extent of the effects of the Veteran's neuropathies was not fully known, as the Veteran had never undergone an electromyography study or nerve conduction study. In January 2023, the Veteran submitted a rebuttal of the VA examiner's opinion. In that statement, the Veteran identified a number of medical records that contradicted the examiner's conclusions. Among those records was the presence of a nerve conduction study the Veteran underwent at the West Palm Beach VA Medical Center on November 16, 2016. This oversight, along with a number of other pieces of evidence the Veteran identified in his statement, call into question whether the examiner's opinion was based on a thorough and accurate review of the Veteran's medical history. Because of this, the Board cannot consider the examiner's opinion to be adequate for adjudication purposes. On remand, a new opinion should be obtained that takes full consideration of the Veteran's entire medical history, to specifically include the treatment notes the Veteran identified in his January 2023 statement. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate examiner, other than the examiner who provided the November 2022 opinion, regarding the Veteran's documented bilateral shoulder disability. The examiner should review the entire claims file, to include a copy of this Remand, and the opinion should include discussion of the Veteran's documented history and assertions. The examiner should render an opinion, as to whether it is at least as likely as not (i.e., likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's bilateral shoulder disability was caused or aggravated by his bilateral varicose veins disabilities and associated peripheral neuropathy. The opinion should specifically address whether the bilateral varicose veins and/or peripheral neuropathy caused pain or weakness that made the Veteran more susceptible to falls, and whether such falls caused or aggravated the Veteran's current bilateral shoulder condition. In providing this opinion, the examiner should address the medical notes highlighted by the Veteran in his January 2023 statement in which he refuted the findings of the November 2022 VA examiner. The examiner should set forth all examination findings, along with complete rationale for the conclusions reached, in a printed report. Complete rationale should include an explanation of the evidence used in support of the conclusion, as well as an explanation as to why such evidence supports the conclusion. 2. Then, readjudicate the appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Giaquinto, 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.