Citation Nr: 18160418
Decision Date: 12/27/18	Archive Date: 12/26/18

DOCKET NO. 16-42 623
DATE:	December 27, 2018

REMANDED
Entitlement to service connection for a left shoulder disorder is remanded.
Entitlement to service connection for a right shoulder disorder is remanded.
Entitlement to service connection for left hand and thumb disorder is remanded.
Entitlement to service connection for right hand and thumb disorder is remanded.
REASONS FOR REMAND
The Veteran served on active duty from May 1971 to November 1973.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in St. Louis, Missouri.
The Veteran asserts that his current bilateral shoulder and bilateral hand and thumb disorders were caused by service.
The Veteran’s service treatment records show that the Veteran had left shoulder pain for the past three years due to a football injury.  See May 1972 STR.  The Veteran also jammed his thumb while playing football and was diagnosed with left thumb strain.  See September 1972 STR.  In the same month the Veteran began complaining of right shoulder pain due to a football game injury.  See September 1973 STR.  See also August 1972 STR (reflecting the Veteran’s complaints of recurrent shoulder pain).  Lastly, after sustaining a left hand strain, he was told not to play football.  See October 1973 STR. 
The Veteran was afforded a VA examination in August 2016.  The examiner found the Veteran to have arthritis in most of his joints including the knees, cervical spine, thoracolumbar spine, bilateral hips, right ankle, bilateral shoulders, and bilat hands.  The examiner opined that the sprains and strains the Veteran received while in service would not have caused the Veteran’s arthritis.  The examiner reasoned that it is likely that the material properties of the Veteran’s cartilage or bone are inferior thus resulting in the development of arthritis over his entire body.  See August 2016 VA C&P Examination Report.
The Board notes that during service, all of the Veteran’s complaints regarding his shoulder, hand, and thumb injuries were due to his playing football.  While the examiner determined that the Veteran’s inservice complains of muscle stains would not have caused his arthritis, the examiner did not render an opinion on whether the Veteran’s participation in football may have precipitated his current shoulder and hand arthritis.  Further, the Veteran has alleged that the joint pains he complained about in service were early stages of arthritis.  See September 2016 Form 9.  As this is a medical determination the Board cannot decide this issue and an addendum medical opinion is necessary.  See 38 C.F.R. § 4.2 (2017); see also Colvin v. Derwinkski, 1 Vet. App. 171, 175 (1991) (if the medical evidence of record is insufficient, the Board is free to supplement the record by seeking an advisory opinion or ordering a medical examination).  Accordingly, the claim must be remanded for another VA examination.
The matters are REMANDED for the following action:
1. Make arrangements to obtain any outstanding VA medical records dated since May 2018.
2. Thereafter, schedule the Veteran for an appropriate VA examination, to evaluate his shoulders and hands/thumbs.  
The entire claims file and a copy of this REMAND must be made available to the examiner in conjunction with the examination.  The examiner must note in the examination report that the evidence in the claims file has been reviewed.  
The examination should include any diagnostic testing or evaluation deemed necessary by the examiner.  
The examiner should identify all current shoulder and hand/thumb disorders found to be present.
The examiner must complete the following:
(a)  Obtain a full and complete statement from the Veteran attesting to the degree to which he played football in service, as well as a description of any injuries he suffered. 
(b) Determine whether it is at least as likely as not (50 percent or greater probability) that any current shoulder and/or hand/thumb disorder had its clinical onset during active service or is related to any incident of service, to include the Veteran’s participation in football and/or any traumatic injuries suffered while playing football. 
In providing this opinion, the examiner should consider and address the following:
*  The Veteran’s assertion that his in-service complaints of pain were an early manifestation of his later diagnoses of acromioclavicular joint osteoarthritis in his bilateral shoulders and mild degenerative arthritis in his bilateral hands;
*  Service treatment record note that the Veteran has had left shoulder pain due to a football injury.  See May 1972 STR
*  Service treatment record note that the Veteran complained of recurring shoulder pain.  See August 1972 STR.
*  Service treatment record note that the Veteran was playing football on August 31, 1972 and jammed his thumb.  See September 1972 STR.
*  Service treatment record note that the Veteran was playing football and hurt his right shoulder.  See September 1973 STR.
*  Service treatment record note that the Veteran strained his left hand and was told not to play football.  See October 1973 STR.
The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached.
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The term “at least as likely as not” does not mean “within the realm of medical possibility.”  Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor it as it is to find against it.
 
P.M. DILORENZO
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Sinckler, Associate Counsel

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