Citation Nr: 25003783 Decision Date: 03/19/25 Archive Date: 03/19/25 DOCKET NO. 20-14 407 DATE: March 19, 2025 REMANDED Entitlement to service connection for a right shoulder disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1977 to May 1999, including foreign service. For his meritorious service, the Veteran was awarded (among other decorations) the Army Commendation Medal and Army Achievement Medal. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified during a March 2021 virtual hearing. A transcript of this proceeding has been associated with the record. Historically and in pertinent part, service connection was denied by the Board in December 2023. Upon receipt of a Joint Motion for Partial Remand (JMPR), the Court of Appeals for Veterans Claims (Court) vacated the Board's determination and remanded the matter for further review in October 2024. In their JMPR, the parties noted that a direct nexus opinion had yet to be obtained, despite evidence in the Veteran's service treatment records (STRs) of right shoulder symptoms. On remand, an opinion which addresses this theory of entitlement is required. Additionally, several secondary VA opinions have previously been obtained. However, these examinations are flawed for the examiners' collective failures to contemplate the specifics of this Veteran's case; to address his testimony regarding the nature and onset of his symptoms; or to address his contention that the claimed disability is etiologically related to overuse in accommodating his service-connected left shoulder disability. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see VA opinions dated July 2018, October 2021, February 2022, and October 2022. A complete and adequate secondary opinion must also be pursued on remand. The matter is REMANDED for the following action: Obtain an addendum opinion addressing the questions below. If the examiner determines that the opinions cannot be offered without evaluation of the Veteran, an examination must be scheduled. The claims file and a copy of this remand must be made available for review. The examiner must definitively state that the Veteran's file was reviewed in support of their opinions. The examiner is asked to offer medical opinions as to: (1) Is it at least as likely as not that the Veteran's right shoulder disorder began in service, was caused by service, or is otherwise related to service? The examiner must explicitly address reports in the Veteran's STRs of relevant treatment, including (but not limited to) in August 1984 and April 1996. (2) Is it at least as likely as not that that the Veteran's right shoulder disorder was caused or aggravated by his service-connected left shoulder disorder or the treatment thereof? Here, the examiner must explicitly address the Veteran's reports that his left shoulder required overuse of the right, contributing to the current condition. Consistent with Lynch v. McDonough, 21 F.4th 776, 781-82 (2021), the examiner is advised that the term "at least as likely as not" means that the likelihood is at least approximately balanced or nearly equal, if not higher. A finding of "aggravation" does not require a permanent worsening of the disorder; rather, any incremental increase in a nonservice-connected condition attributable to a service-connected disability, whether permanent or not, constitutes aggravation. Ward v. Wilkie, 31 Vet. App. 233, 240 (2019). [CONTINUED ON NEXT PAGE] A complete rationale should be provided for all opinions or conclusions expressed. It should be noted that the Veteran is competent to attest to observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kovarovic, Kate 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.