Citation Nr: 24005602 Decision Date: 02/02/24 Archive Date: 02/02/24 DOCKET NO. 18-35 806 DATE: February 2, 2024 REMANDED The issue of entitlement to service connection for a left shoulder disability, to include degenerative changes, is remanded. The issue of entitlement to service connection for degenerative changes of the right shoulder is remanded. The issue of entitlement to service connection for an acquired psychiatric disability other than posttraumatic stress disorder (PTSD) with alcohol and cannibis use disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1972 to June 1975. This appeal arises from a December 2014 rating decision which, in relevant part, denied service connection for PTSD, an acquired mental condition other than PTSD, a cervical spine disability, radiculopathy affecting the left and right upper extremity, and degenerative changes in the left and right shoulder. The Veteran perfected an appeal as to those issues and, during the appeal, testified before the undersigned Veterans Law Judge (VLJ) during a hearing in February 2022. In August 2022, the Board remanded the claims on appeal for evidentiary development and, notably, re-styled ones of the issues as entitlement to service connection for a left and right shoulder disability, to include degenerative changes and cervical radiculopathy. While the appeal was in remand status, the agency of original jurisdiction (AOJ) granted service connection for PTSD with alcohol and cannibis abuse disorder, degenerative disc disease and stenosis of the cervical spine, and radiculopathy affecting the left and right upper extremity. See June 2023 rating decision. As the grant of service connection for those disabilities is considered a full grant of the benefits sought with respect to those claims, they are no longer on appeal before the Board. In September 2023, the Veteran's representative informed the Veteran and VA that he wished to withdraw his representation. In September 2023, VA acknowledged the withdrawal of representation and sent the Veteran a letter informing him that he could contact VA for a listing of recognized Veterans Service Organizations and/or representatives. To date, the Veteran has not appointed a new representative and, thus, he is unrepresented. 1. Entitlement to service connection for a left shoulder disability, to include degenerative changes and shoulder strain, is remanded. 2. Entitlement to service connection for degenerative changes of the right shoulder is remanded. In the August 2022 remand, the Board requested the Veteran be afforded a VA examination to identify the Veteran's shoulder disabilities and obtain an opinion that addressed if the shoulder disabilities had clinical onset during service, are otherwise related to service, to include a motor vehicle accident (MVA) during service, or are secondary to (caused or aggravated by) his cervical spine disability. During a May 2023 VA examination, the Veteran was diagnosed with left shoulder strain and bilateral acromioclavicular (AC) osteoarthritis, and the examiner provided negative opinions regarding direct and secondary service connection. As for secondary service connection, the examiner generally stated that they were unable to justify a secondary connection to the cervical spine complaints but also opined that the shoulder disabilities are less likely aggravated by the cervical spine disability. In this regard, the examiner noted the Veteran did not report any subjective right shoulder complaints during the examination, that AC joint arthritis is seen bilaterally, and that the left shoulder strain is of acute etiology and separate from the MVA during service. The foregoing opinion is incomplete because the examiner did not address the causation element of secondary service connection and the rationale provided for the aggravation element does not adequately explain why left shoulder arthritis and strain are not or have not been aggravated by the cervical spine disability. In this context, the Board notes that an additional opinion is needed to address if the Veteran's newly service-connected radiculopathy disabilities caused or aggravate the degenerative changes in his bilateral shoulders or left shoulder strain. 3. Entitlement to service connection for an acquired psychiatric disability other than posttraumatic stress disorder (PTSD) with alcohol and cannibis use disorder is remanded. In the August 2022 remand, the Board requested the Veteran be afforded a VA examination to determine the nature and etiology of all current psychiatric disorders. The Board requested the examiner list all disabilities diagnosed on examination but also discuss if any previous diagnoses of record were incorrect. In this regard, a November 2014 VA treatment record reflects that the Veteran was variously diagnosed with PTSD or unspecified traumatic or stressor related disorder, unspecified depressive disorder, and alcohol use disorder. The Veteran was subsequently provided a VA examination in June 2023 and was diagnosed with PTSD, alcohol use disorder, and cannibis use disorder. The examiner opined that the Veteran experienced several traumatic events during service and used alcohol and cannibis to self-medicate for chronic pain and PTSD symptoms. As a result, the AOJ granted service connection for those disabilities. However, the June 2023 VA examiner did not address the previous diagnosis of unspecified depressive disorder which, for the purposes of this claim, is considered a current disability for which a nexus opinion must be obtained unless the diagnosis is deemed incorrect or part and parcel of the service-connected disability. Therefore, a remand is needed to obtain a medical opinion that addresses the foregoing. The matters are REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran's claims file and provide opinions as to the following: (a) Did the Veteran's left and right shoulder disabilities, including degenerative changes and left shoulder strain, have its onset during service or due to an event or incident of the Veteran's period of active service. (b) Were the Veteran's left and right shoulder disabilities (A) caused or (B) aggravated beyond normal progression by the service-connected cervical spine and radiculopathy disabilities? Opinions must be provided regarding causation and aggravation by the cervical spine, left upper extremity radiculopathy, and right upper extremity radiculopathy disabilities. Aggravation means an increase in disability - any additional impairment of earning capacity - of the nonservice-connected disability. Aggravation also includes situations where the claimed disability would be less severe and result in less functional impairment but for the service-connected disability because the service-connected disability results in the inability to treat the claimed disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. Arrange for an appropriate health care provider to review the Veteran's claims file and provide an opinion regarding the diagnosis of unspecified depressive disorder reflected in the November 2014 VA treatment record. (a) If needed, the health care provider chosen to provide the opinion may address if the diagnosis was competent and consistent with the DSM-5 or incorrect. A rationale must be provided for any response to the foregoing. (b) If deemed competent, did the diagnosis of unspecified depressive disorder have its clinical onset during service or due to an event or incident of the Veteran's period of active service, including the traumatic events noted during the June 2023 VA examination? If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Turnipseed, 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.