Citation Nr: 23012131 Decision Date: 02/28/23 Archive Date: 02/28/23 DOCKET NO. 18-39 502 DATE: February 28, 2023 REMANDED Entitlement to service connection for a left shoulder condition, as secondary to his left knee condition, is remanded. REASONS FOR REMAND The Veteran had active service from August 1978 to October 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal of an April 2018 rating decision issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). In June 2020, the Veteran testified at a videoconference hearing held before the undersigned Veterans Law Judge, and a transcript of that hearing has been associated with the claims file. In November 2022, the Board remand this claim for additional development. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue on appeal. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). In November 2022, the Board instructed the AOJ to obtain an addendum opinion regarding whether the Veteran's service-connected left knee condition caused or aggravated his left shoulder condition. Specifically, the Board instructed a VA medical examiner to opine: 1) whether it is at least as likely as not (a nearly 50 percent or greater probability) that any current disability and/or functional impairment of left shoulder has been caused by the service-connected left knee condition; and 2) Whether it is at least as likely as not (a nearly 50 percent or greater probability)that the Veteran's left knee disability has caused a medically discernible worsening of functional impairment of the Veteran's left shoulder condition (e.g., any additional functional impairment beyond the baseline level of disability)? Further, the examiner was requested to consider and discuss the Veteran's assertions his left knee would "give out" causing him to fall and explain whether the mechanism of injury described by the Veteran have been sufficiently severe to result in any current abnormalities of the left shoulder. Additionally, the examiner was asked to discuss whether any aspect of left knee impairment is medically capable of causing additional disability or functional impairment of the left shoulder and, if so, whether there is any additional functional impairment shown in this case The AOJ obtained an addendum opinion in December 2022. The VA examiner opined that "it is less likely than not that the claimed left shoulder condition is proximately due to the Veteran's left knee condition. The condition is more likely due to the Veteran's age, occupation, sports, and chronic degenerative changes. To say that the Veteran's injury decades ago is the main/most likely/greater than 50% probability, cause of the Veteran's left shoulder condition, would be considered not the medical accepted standard of care/opinion." Regarding aggravation, the examiner provided the identical reasoning, stating that the Veteran's shoulder condition is more likely due to the Veteran's age, occupation, sports, and chronic degenerative changes. After review of the opinion, the Board finds that another remand is required to obtain a new addendum medical opinion. First, the provided reasoning is inadequate the examiner applied a higher standard than is required to establish service connection. Specifically, the examiner based the negative opinion on the standard of "main/most likely/greater than 50% probability," which is a higher standard than required to establish service connection. Secondly, the provided opinion regarding secondary service connection is inadequate because it failed to provide adequate reasoning regarding aggravation, and simply restated the previously provided opinion. Lastly, although the examiner provided an opinion regarding the likely cause of the Veteran's shoulder condition, the examiner failed to discuss the Veteran's assertions his left knee would "give out" causing him to fall and explain whether the mechanism of injury described by the Veteran have been sufficiently severe to result in any current abnormalities of the left shoulder. Thus, the Board finds the December 2022 VA addendum opinion rationale inadequate, as it is conclusory, and not supported by sufficient medical evidence. As such, further development is warranted The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. After associating any additional records with the claims file, forward the Veteran's claims file to an appropriate VA examiner, other than the December 2022 examiner, for an addendum opinion. The examiner should conduct a new examination if necessary for an adequate opinion. The examiner is asked to provide a response to the following: (a.) Whether it is at least as likely as not (a nearly 50 percent or greater probability) that any current disability and/or functional impairment of left shoulder has been caused by the service-connected left knee condition, to include the Veteran's left knee "giving out" causing the Veteran to fall on his shoulder? (b.) Whether it is at least as likely as not (a nearly 50 percent or greater probability) that the Veteran's left knee disability, to include the Veteran's left knee "giving out" causing the Veteran to fall, has caused a medically discernible worsening of functional impairment of the Veteran's left shoulder condition (e.g., any additional functional impairment beyond the baseline level of disability)? In rendering the requested opinion, the examiner must consider and discuss the Veteran's assertions his left knee would "give out" causing him to fall and explain whether the mechanism of injury described by the Veteran have been sufficiently severe to result in any current abnormalities of the left shoulder. Additionally, the examiner should discuss whether any aspect of left knee impairment is medically capable of causing additional disability or functional impairment of the left shoulder and, if so, whether there is any additional functional impairment shown in this case. Lastly, the examiner must provide all findings, along with a complete rationale for his or her opinion(s). The examiner must not rely solely on the absence of a diagnosis or symptoms in service as the basis for a negative opinion. It is also noted that the mere passage of time without treatment is not a sufficient basis for finding that no relationship between a current disability and service exists. Any opinion should be reconciled with the service treatment and personnel records, any post-service diagnoses, lay statements, and testimony of the Veteran. If the lay evidence is rejected, an explanation must be provided. If an opinion cannot be made without resort to speculation, please state so and include an explanation for that conclusion. 3. Thereafter, the AOJ should ensure that the VA opinion addresses all remand directives. 4. Thereafter, readjudicate the claims. If any benefit sought on appeal remains denied, furnish the Veteran and his representative, if any, a supplemental statement of the case and an appropriate period of time to respond. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Brady, 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.