Citation Nr: 25003979 Decision Date: 03/25/25 Archive Date: 03/25/25 DOCKET NO. 18-19 605 DATE: March 25, 2025 REMANDED Entitlement to service connection for a right shoulder disability, to include as secondary to service-connected degenerative arthritis and intervertebral disc syndrome of the cervical spine (cervical spine disability) and/or upper extremity radiculopathy, is remanded. Entitlement to service connection for a left shoulder disability, to include as secondary to a service-connected cervical spine disability and/or upper extremity radiculopathy, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from September 1966 to September 1970. He also had service in the U.S. Navy Reserve. His decorations include the Vietnam Service Medal. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By that decision, the RO denied service connection for disabilities of the shoulders. In prior dispositions, the Board also accepted jurisdiction of the issue of the Veteran's entitlement to a TDIU. The issues on appeal were previously before the Board in February 2021, August 2023, and June 2024, when they were remanded to the agency of original jurisdiction (AOJ) for additional development. In the most recent remand, the Board directed the AOJ to obtain addendum VA medical opinions with respect to the etiology of the Veteran's shoulder disabilities. In July 2024, the AOJ obtained addendum VA medical opinions, as directed. However, in a subsequent, February 2025 submission, the Veteran's representative contended that one of the medical articles to which the July 2024 VA examiner cited was supportive of the Veteran's claims, and that the VA examiner had therefore improperly relied upon it in formulating her nexus opinions. Still further, the representative submitted two additional medical articles related to the Veteran's claims. In light of the Veteran's specific contentions with respect to the medical article upon which the VA examiner relied, the submission of additional relevant medical articles, and in order to afford the Veteran every possible consideration, the Board finds that further development is warranted. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to service connection for a right shoulder disability, to include as secondary to a service-connected cervical spine disability and/or upper extremity radiculopathy, is remanded. 2. Entitlement to service connection for a left shoulder disability, to include as secondary to a service-connected cervical spine disability and/or upper extremity radiculopathy, is remanded. As noted, in its most recent, June 2024 remand, the Board directed the AOJ to obtain addendum VA medical opinions as to the etiology of the Veteran's shoulder disabilities. Specifically, the Board directed that the examiner was to consider a medical article submitted by the Veteran in October 2022 regarding the structure, function, and control of the human musculoskeletal network, and to offer an opinion as to how the article impacted the opinions as to secondary service connection that were previously offered by a VA examiner in November 2023. In July 2024, the AOJ obtained addendum medical opinions from a VA examiner other than the VA examiner who offered the nexus opinions in November 2023. The new examiner offered negative nexus opinions as to secondary service connection, and as to both shoulders. In so doing, she specifically considered and addressed the article submitted by the Veteran in October 2022. In support of her negative nexus opinions, the examiner also cited to another medical article titled "Rotator Cuff Tendonitis." Subsequently, in a February 2025 submission, the Veteran's representative contended that the article regarding rotator cuff tendonitis upon which the July 2024 VA examiner relied in offering her negative nexus opinions supported an award of service connection. He highlighted that the article noted that a thorough history included any history of injury and/or trauma to the shoulders and/or neck, and any relevant surgical history, and that coexisting cervical radiculopathy should be ruled out when evaluating shoulder disabilities. In essence, the Veteran contends that the July 2024 VA examiner cited to a portion of the medical article regarding rotator cuff tendonitis to support her negative nexus opinion, when another portion of the article supported awards of service connection. Along with the February 2025 submission, the Veteran submitted two additional medical articles regarding a possible connection between neck and shoulder disabilities, as well as a copy of the article regarding rotator cuff tendonitis cited by the July 2024 VA examiner. In light of the Veteran's contentions as set forth in the February 2025 submission, along with the additional medical articles submitted at that time, the Board finds that a remand for another addendum opinion is warranted so that the VA examiner can consider all of the Veteran's contentions and all of relevant evidence of record in formulating her opinion. Updated records of VA treatment should also be procured. Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). 3. Entitlement to a TDIU is remanded. As noted by the Board in its prior remand, the Veteran contended in his April 2024 application for a TDIU that his shoulder disabilities, in part, prevented him from securing or following a substantially gainful occupation. In light of that assertion, the Board finds that the Veteran's claim for a TDIU is inextricably intertwined with his claims for service connection for shoulder disabilities, which are being remanded. See, e.g., Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 2 Vet. App. 180, 183 (1991) (issues are "inextricably intertwined" when a decision on one issue would have a "significant impact" on an appellant's claim for another issue). As such, the Board will remand the TDIU claim as well. These matters are REMANDED for the following action: 1. Obtain copies of records of any VA treatment the Veteran has received since such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 2. After the foregoing development has been completed, arrange to provide the record on appeal to the VA examiner who offered opinions as to secondary service connection with respect to the Veteran's shoulder disabilities in July 2024. The examiner should review the record. After reviewing the record, the examiner should prepare an addendum opinion indicating to what extent, if any, the medical articles submitted by the Veteran in February 2025, regarding a possible connection between neck and shoulder disabilities, impact the opinions she previously offered in July 2024. The examiner must also consider and address the Veteran's specific contentions with respect to the medical article regarding rotator cuff tendonitis that the examiner cited in her July 2024 opinions, as set forth in a February 2025 submission. Specifically, the examiner must consider and address the Veteran's contention that portions of that medical article support an award of service connection for the Veteran's shoulder disabilities, including the portions of the article indicating that a thorough history includes any history of injury and/or trauma to the shoulders and/or neck, and any relevant surgical history, and that coexisting cervical radiculopathy should be ruled out when evaluating shoulder disabilities. If the July 2024 VA examiner is no longer employed by VA or is otherwise unable to offer the requested opinion, arrange to obtain the requested information from another qualified examiner. The need for another in-person examination, or video or telephone interview of the Veteran is left to the discretion of the examiner. A complete medical rationale for all opinions expressed must be provided. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues remaining on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Oldroyd, 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.