Citation Nr: 23018409 Decision Date: 03/24/23 Archive Date: 03/24/23 DOCKET NO. 17-64 859 DATE: March 24, 2023 REMANDED Entitlement to service connection for arthritis of the right shoulder, to include as due to the service-connected right elbow disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1980 to March 2001. The Veteran had a hearing before the undersigned Veterans Law Judge in December 2022. A copy of the transcript is of record and has been reviewed accordingly. The Veteran contends that he currently suffers from a right shoulder disability that is the result of military service. At the hearing he attributed his current shoulder disability to his service-connected right elbow disability as well as the underlying in-service injury that led to the development of that service-connected elbow disability in the first place. The Veteran's contention was that the force of the impact that damaged his right elbow also damaged his right shoulder, and that the traction used to treat the right elbow injury, caused damaged the right shoulder, resulting in the right shoulder disability currently seen. In this regard, the Veteran was provided with a VA examination for his right shoulder in October 2017. The examiner provided a negative etiology opinion for the issue of secondary service connection, indicating that the right elbow injury and its treatment with 2 surgeries were less likely than not the precursors to the development of his right shoulder disability. The reasoning was that the elbow and shoulder were distinct conditions, and the claims file was silent with respect to any injury to the shoulder that could be linked to current shoulder conditions. However, the examiner appears to have stopped short of opining on the issue of there being any link between the injury to the elbow as also a possible cause for the right shoulder disability. The Veteran has submitted a March 2023 private opinion. While this opinion did not make clear if the referenced service injury was to the elbow or a shoulder dislocation during a period of traction, the opinion was to the effect that 2015 right shoulder MRI findings are the result of the Veteran's service injury. (The MRI appeared to show impairment of the rotator cuff, coracoacromial arch, glenohumeral joint, and osseous/bone marrow.) In light of the above, the Board finds that the issue of direct service connection has not been adequately developed by the evidence currently of record. The 2017 VA examiner did not address it and the 2023 private provider did not provide a supporting rationale. Therefore, the Veteran's claim should be returned in order to obtain an addendum opinion which addresses the theory of direct service connection, to include a properly supported rationale for any opinions rendered. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate person addressing the etiology of the Veteran's right shoulder disability. It is left to the discretion of the provider as to whether an in-person examination is required. The Veteran's claims file should be provided to the reviewer. With a complete supporting rationale, the reviewer should opine whether it is as least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's current right shoulder disability was caused by or incurred in military service, to include consideration of the Veteran's in-service basketball injury that led to the development of his already service-connected right elbow disability. In addressing this issue, the reviewer should discuss the arm complaints due to traction noted in the service treatment records, and the likelihood the Veteran sustained a shoulder dislocation or other shoulder injury when his elbow was placed in traction during service, and the likelihood that such a shoulder injury initiated the impairments currently effecting the right shoulder, as seen on 2015 MRI studies. If a nexus with service is not found, a discussion of likely causes for the present findings would be helpful. 2. Readjudicate the claim. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dodd, Ryan 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.