Citation Nr: 1032091 Decision Date: 08/26/10 Archive Date: 09/01/10 DOCKET NO. 07-25 867 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Roanoke, Virginia THE ISSUES 1. Entitlement to service connection for a left shoulder disability. 2. Entitlement to service connection for a skin disability, to include as due to an undiagnosed illness. REPRESENTATION Veteran represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL The Veteran and his spouse ATTORNEY FOR THE BOARD V. Chiappetta, Associate Counsel INTRODUCTION The Veteran served on active duty in the United States Army from February 1980 to February 1983, and from January 7, 1991 to June 23, 1991. Service in Southwest Asia is indicated by the evidence of record. This matter is before the Board of Veterans' Appeals (the Board) on appeal of an October 2006 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia, which denied the Veteran's service-connection claims for a left shoulder injury with dislocation, and for dermatitis of the back and shoulders. The Veteran disagreed with these decisions, and perfect appeals as to both issues. In June 2010, the Veteran testified at a personal hearing which was chaired by the undersigned Veterans Law Judge at the Board's offices in Washington D.C. A transcript of the hearing has been associated with the Veteran's VA claims folder. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. REMAND After having carefully considered the matter, and for reasons expressed immediately below, the Board believes that these issues must be remanded for further evidentiary development. Left shoulder disability The Veteran asserts that he has a current left shoulder disability that is related to an injury he sustained during his second period of active duty military service in 1991. Concerning the Veteran's current diagnosis, the record is unclear as to whether the Veteran in fact has a current disability affecting his left shoulder. Although the Veteran was diagnosed with impingement syndrome of the left shoulder in April 1995, bursitis in July 1995, and a left shoulder dislocation in January 2001, a more recent September 2006 QTC examiner specifically indicated upon examination of the Veteran's left shoulder that "there is no diagnosis because there is no pathology to render a diagnosis." See the April 25, 1995 treatment report of Dr. J.M.M, the July 26, 1995 and January 1, 2001 treatment reports of Dr. H., and the September 2006 QTC examiner's report respectively. The Board notes that the September 2006 examiner did not order magnetic resonance imaging (MRI) testing of the Veteran's left shoulder, but rather based his overall assessments in part on x- ray findings alone. Further, the September 2006 examiner made no mention of the previous diagnoses of shoulder dislocation, bursitis, and impingement syndrome noted above. The Veteran continues to assert that he cannot rotate his left shoulder completely, as doing so could cause another dislocation. See the Veteran's January 2007 Notice of Disagreement; see also the June 2010 hearing transcript, page 6. Concerning in-service injury, the record is unclear as to whether the Veteran's current shoulder disability [if diagnosed] had its onset prior to the Veteran's re-entry into active duty service in January 1991, or at any time subsequent. It is undisputed that the Veteran fell and injured his left shoulder in February 1991 during active duty mountain training. He was diagnosed with left shoulder sublaxation. See the Veteran's February 5, 1991 Consultation Sheet. The Veteran currently contends that his shoulder was separated in February 1991 and had to set back. See the June 2010 hearing transcript, pages 5 and 6. The Board notes however that a January 1991 examiner specifically indicated in a Report of Medical History that the Veteran dislocated his left shoulder in April 1990, had occasional sublaxation, and may need rotator cuff repair in the future, but was asymptomatic at the time. See the Veteran's January 8, 1991 Report of Medical History. Indeed, the Veteran acknowledged this prior dislocation when he was receiving treatment for his in- service February 1991 left shoulder injury. Subsequently, in April 1991, the Veteran described his February 1991 injury as a "redislocation" of the shoulder. See the Veteran's April 29, 1991 Chronological Record of Medical Care. Finally, concerning etiology, there are no medical opinions of record relating a current left shoulder disability either to the Veteran's in-service left shoulder injury in February 1991, or to a pre-existing injury that was aggravated beyond its normal progression by the Veteran's active duty service in 1991. As such, this case presents certain medical questions which cannot be answered by the Board. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) [the Board is prohibited from exercising its own independent judgment to resolve medical questions]. These questions concern the Veteran's current diagnosis, if any, of his claimed left shoulder disability, and whether a relationship, if any, exists between this disability and his period of active service from January 1991 to June 1991, to include whether any diagnosed left shoulder disability pre-existed the Veteran's reenlistment in 1991, and was aggravated beyond its normal progression during service. These questions must be addressed by an appropriately qualified physician. See Charles v. Principi, 16 Vet. App. 370 (2002); see also 38 C.F.R. § 3.159(c)(4) (2009) [a medical examination or opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim]. Skin disability The Veteran contends that he has a current skin disability that is related to an undiagnosed illness associated with his verified service in Southwest Asia during the Persian Gulf War. In July 1995, the Veteran was diagnosed with a pustular rash and acne on his left shoulder. See the Veteran's July 26, 1995 private treatment report of Dr. H. The Veteran asserts that he currently has bumps appearing on his chest and back. See the June 2010 hearing transcript, page 15. A clear diagnosis and etiology of the Veteran's claimed skin disability have not been identified. As such, this case also presents certain medical questions which cannot be answered by the Board. See Colvin, 1 Vet. App. at 175. As above, these questions concern the Veteran's current diagnosis, if any, of his claimed skin disability, and whether a relationship, if any, exists between the Veteran's skin disability and his period of active service in Southwest Asia in 1991, to include whether such could be attributed to an undiagnosed illness. These questions must be addressed by an appropriately qualified physician. See Charles v. Principi, 16 Vet. App. 370 (2002); 38 C.F.R. § 3.159(c)(4) (2009). Accordingly, the case is REMANDED to the Veterans Benefits Administration (VBA) for the following action: 1. VBA should contact the Veteran and request that he identify any additional medical treatment he has received for his claimed left shoulder and skin disabilities. VBA should take appropriate steps to secure copies of any such treatment reports identified by the Veteran which are not in the record on appeal. Efforts to obtain these records should also be memorialized in the Veteran's VA claims folder. 2. VBA should then schedule the Veteran for a VA physical examination, to include MRI testing, to determine the nature and etiology of his claimed left shoulder disability. The Veteran's claims folder should be forwarded to and reviewed by the examiner. Upon review of the Veteran's medical history, and upon examination of his shoulder, the examiner should provide opinions with supporting rationale as to the following questions: (a). Does the Veteran have a current left shoulder disability? If so, did this disability have its onset prior to the Veteran's re-entry into active military service in January 1991? (b). If the Veteran has a current left shoulder disability that pre- dated the Veteran's re-entry into active military service in January 1991, is it as likely as not that the Veteran aggravated this shoulder disability beyond its normal progression during his active duty service? (c). If the Veteran has a current left shoulder disability that did not pre-date the Veteran's re-entry into active military service in January 1991, is it as likely as not that this current disability is related to the Veteran's in-service left shoulder injury described above? All diagnostic testing or specialist consultation deemed necessary should be scheduled. A report should be prepared and associated with the Veteran's VA claims folder. The examiner is requested to provide the basis for all opinions reached. 3. VBA should also schedule the Veteran for a VA skin examination. The Veteran's claims folder should be forwarded to and be reviewed by the examiner. Upon review of the Veteran's medical history and upon examination of his skin, the examiner should determine whether the Veteran's claimed skin condition is a symptom of another disorder (either diagnosed or undiagnosed) or whether it itself is a diagnosed disease entity. If a skin disability is diagnosed, the examiner should provide an opinion, with supporting rationale, as to whether it is as likely as not that such disability is due to the Veteran's military service. If there is no diagnosed skin disability as such, but rather the skin condition is associated with another disability, to include an undiagnosed disability due to Persian Gulf service, this should be made clear. Finally, if the Veteran currently has no indication of any skin condition or disability, such should also be made clear. All diagnostic testing or specialist consultation deemed necessary should be scheduled. A report should be prepared and associated with the Veteran's VA claims folder. The examiner is requested to provide the basis for all opinions reached. 4. After undertaking any additional development which it deems to be necessary, VBA should then readjudicate the Veteran's service-connection claims. If the benefits sought on appeal remain denied, the Veteran should be provided a supplemental statement of the case and given an appropriate opportunity to respond. Thereafter, the case should be returned to the Board for further consideration, if otherwise in order. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ DAVID L. WIGHT Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2009).