Citation Nr: 18131279
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 16-03 228
DATE:	August 31, 2018
REMANDED
Entitlement to service connection for left deltoid atrophy secondary to service-connected left shoulder disability is remanded.
Entitlement to a disability rating in excess of 10 percent for service-connected osteopenia of the left shoulder is remanded.
REASONS FOR REMAND
The Veteran served on active duty from March 1969 to January 1973.  These matters come to the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated in April 2015 and May 2015 by a Department of Veterans Affairs (VA) Regional Office (RO).  
The Veteran submitted a RAMP opt-in election form in April 2018; however, the appeal with respect to the service connection claim for left deltoid atrophy had already been activated at the Board and is therefore no longer eligible for the RAMP program.  With respect to the increased rating claim for osteopenia of the left shoulder, that claim is also not eligible for RAMP, because the Veteran has not perfected the appeal with respect to this issue.  

1. Entitlement to service connection for left deltoid atrophy secondary to service-connected left shoulder disability is remanded.
The Veteran underwent a VA examination in May 2015 with respect to his service connection claim for left deltoid atrophy.  The examiner provided the opinion that the Veteran’s atrophy of the left deltoid muscle is a disuse atrophy associated with chronic pain from degenerative joint disease of the acromioclavicular (AC) joint and chronic calcific tendinitis, and not due to osteopenia of the left shoulder.  The examiner did not address whether the Veteran’s service-connected osteopenia of the left shoulder aggravated the Veteran’s atrophy of the left deltoid muscle.  Thus, a VA examination and medical opinion should be provided to adequately address the issue of whether the atrophy of the left deltoid muscle is secondary to his service-connected disabilities.
Furthermore, the evidence reflects that the Veteran was originally in receipt of service connection for left shoulder strain as secondary to his service-connected right elbow disability.  After a July 2007 VA examination, the RO determined that service-connected for osteopenia of the left shoulder more adequately represented the Veteran’s current disability.  The Board observes that the July 2007 VA examiner also determined that it is at least as likely as not that the Veteran’s arthritis of the left shoulder is secondary to the service-connected repair for fracture of the right elbow.  This suggests that the arthritis of the left shoulder might be a progression of the Veteran’s service-connected left shoulder disorder as secondary to his service-connected right elbow disability.  As the VA examiner in May 2015 determined that the Veteran’s left deltoid muscle atrophy is due to disuse atrophy associated with chronic pain from degenerative joint disease of the AC joint and chronic calcific tendinitis and there is evidence indicating that the Veteran’s degenerative joint disease of the left shoulder might be a progression of his left shoulder disability, the Board finds that a VA examination and medical opinion addressing this issue is also necessary prior to adjudicating the Veteran’s service connection claim.

2.  Entitlement to a disability rating in excess of 10 percent for service-connected osteopenia of the left shoulder is remanded.
In an April 2015 rating decision, the RO denied a disability rating in excess of 10 percent for service-connected osteopenia of the left shoulder.  In the May 2015 notice of disagreement, the Veteran listed in section 10A. of VA Form 21-0958 that the previously assigned 10 percent for this condition has become worse since the initial evaluation.  He indicated that the area of disability is the evaluation of the disability in section 10B.  In Section 11A, the Veteran specifically discussed why his left shoulder disability warrants a higher rating.  Accordingly, the Board interprets that this is a disagreement with the April 2015 rating decision that denied an increased rating for his left shoulder osteopenia.  He has not been issued a statement of the case regarding this issue.  Thus, a remand is required for issuance of a statement of the case.  See 38 C.F.R. § 19.9(c).  The Veteran will then have the opportunity to file a timely substantive appeal if he wishes to complete an appeal as to the issue of entitlement to a higher disability rating osteopenia of the left shoulder.
The matters are REMANDED for the following action:
1.  Arrange for the Veteran to undergo a VA examination with respect to his service connection claim for left deltoid muscle atrophy secondary to his service-connected disabilities to include his left shoulder disability by an appropriate medical specialist.  
The claims file, including a copy of this remand, must be made available to the examiner for review, and the examiner should document in the examination report that the claims folder was reviewed.  The examiner must record all pertinent medical complaints, symptoms and clinical findings in detail.
After reviewing the claims file and conducting an examination of the Veteran’s left shoulder and left deltoid muscle, the examiner is asked to opine on the following:
(a.) With respect to the Veteran’s previously diagnosed degenerative joint disease of the left AC joint and/or chronic calcific tendinitis of the left shoulder, whether it is at least as likely as not (i.e., a 50 percent or greater probability) a progression of the Veteran’s service-connected left shoulder disability as secondary to his service-connected right wrist disorder.  
(b.) If the answer to (a) is negative, then whether the left deltoid muscle atrophy is at least as likely as not (i.e., a fifty percent or greater probability) caused by or aggravated by his service-connected disabilities to include his left shoulder disability and/or his right wrist disability.  Both causation and aggravation must be addressed.  If aggravation is found, the examiner is asked to establish a baseline level of severity prior to aggravation by the service-connected disability.
The examiner must provide a clear explanation for all conclusions reached.  With respect to question (a), the examiner is asked to address the July 2007 VA examination and medical opinion as part of his or her rationale.
2.  Issue a statement of the case regarding the increased rating claim for osteopenia of the left shoulder, along with a VA Form 9, and afford the Veteran the appropriate opportunity to file a substantive appeal perfecting an appeal on that issue.  The Veteran and his representative are reminded that to obtain appellate review of any matter not currently in appellate status-in this case, entitlement to a disability rating in excess of 10 percent for service-connected osteopenia of the left shoulder -a timely appeal must be perfected.

 
M. HYLAND
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Berry, Counsel

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

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