Citation Nr: 18143008 Decision Date: 10/17/18 Archive Date: 10/17/18 DOCKET NO. 15-38 630 DATE: October 17, 2018 REMANDED Entitlement to service connection for rheumatoid arthritis of various joints, is remanded. Entitlement to service connection for osteoarthritis, degenerative changes of various joints, is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for diverticulitis is remanded. Entitlement to service connection for diabetes mellitus type II is remanded. Entitlement to an initial compensable rating for storage mite syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1984 to November 1988 and November 1990 to May 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by the Department of Veterans Affairs (VA). Evidence in the record suggests that the Veteran has been diagnosed with multiple arthritic conditions. A review of the file also shows that while in service, the Veteran was treated for arthritis (rheumatoid, etc.) which would include all forms of arthritis. Moreover, in the most recent Appellate Brief of September 2018, the Veteran’s representative makes arguments for service connection both as to rheumatoid arthritis and degenerative changes of various joints. Therefore, the Board will broadly construe the issue of service connection for rheumatoid arthritis as a claim for service connection for arthritis, however, diagnosed, as this is the most favorable interpretation of the issue at hand. However, since rheumatoid arthritis is systemic and osteoarthritis and degenerative changes are joint specific, the Board has added an additional issue to the appeal rather than expanded the issue. Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) (holding that the Board must consider any disability that “may reasonably be encompassed by” the description of the claim and symptoms and other submitted information). Entitlement to service connection for an arthritic disability, hypertension, diverticulitis, and diabetes mellitus, and an initial compensable rating for storage mite syndrome, is remanded. The Board notes that further development is necessary to comply with VA's duty to assist the Veteran to obtain evidence needed to substantiate his claim. Initially, the Board notes that there are outstanding treatment records that must be obtained and associated with the claim file. The August 2014 rating decision indicated that regional office (RO) reviewed VA medical records from January 2014 to August 2014. The September 2015 statement of the case (SOC) indicated that the RO reviewed VA medical records from March 2002 to September 2015. At the August 2014 VA arthritis examination, the examiner indicated that he had reviewed diagnostic testing from April 2013 and April 2014. At the August 2014 VA skin examination, the examiner noted a 2011 diagnosis of storage mite syndrome. However, these records are not currently associated with the claim file. Accordingly, the Board will remand to obtain these records. Further, the Board notes that the August 2014 VA arthritis examination is inadequate. The examiner opined that an opinion cannot be rendered because the record does not contain a diagnosis of rheumatoid arthritis. However, the rationale is inadequate because it does not address in-service diagnoses of thoracic spine degenerative changes and reports of back, neck, shoulder, and left arm pain; and treatment regarding suspected rheumatoid arthritis. In this regard, the Veteran specifically contends that service treatment records (STRs) indicated that “his physicians wanted to rule out rheumatoid arthritis after numerous back, neck and shoulder pain complaints.” See September 2018 Informal Hearing Presentation. STRs reflect that a provider ordered an evaluation for rheumatoid arthritis and noted complaints of back, neck, shoulder, and left arm pain (March 1986, April 1986, May 1986, December 1986, February 1987, March 1987, June 1987). VA treatment records reflect diagnoses of osteoarthritis and degenerative changes in hips, and arthritic changes in spine and multiple joints with reports of bilateral hip and joint pain ( August 2014, March 2015, May 2015, September 2015, October 2015, November 2015). As such, a new VA examination is warranted. Finally, the Board notes that the Veteran’s STRs reflect a diagnosis of Sprengel’s deformity (a congenital abnormality of the shoulder blade) (December 1986, February 1987). These condition is identified as a birth defect. See Dorland's Illustrated Medical Dictionary 479, 1757 (32nd ed. 2012). VA does not consider congenital or developmental defects to be diseases or injuries for compensation purposes, and such defects are not generally subject to service connection. 38 C.F.R. §§ 3.303(c), 4.9; see Winn v. Brown, 8 Vet. App. 510, 516 (1996). Service connection is only possible in such cases when there is evidence of additional disability due to aggravation during service of the congenital defect by superimposed disease or injury. See VAOPGCPREC 82-90; Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993); Carpenter v. Brown, 8 Vet. App. 240, 245 (1995); VAOPGCPREC 67-90; VAOPGCPREC 11-99. In this case, the impact of this diagnosis on the Veteran’s disabilities is unclear. As such, remand to obtain an opinion on aggravation is necessary. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from March 2002 to the present. 2. After the development in the first instruction is completed, the AOJ should arrange for a VA examination of the Veteran to determine the nature and likely cause of any arthritic disability, to include rheumatoid arthritis is diagnosed. The examiner should review the claim file (including this remand) and note such review was conducted. Based on review of the record and examination of the Veteran, the examiner should provide an opinion with detailed rationale that responds to the following: (a.) Please identify, by diagnosis, all arthritic disabilities present during the appeal period (from September 2013). In so doing, it should be noted that the record contains diagnoses of osteoarthritis, degenerative changes in the hips, and arthritic changes in the spine and multiple joints, and the service treatment records noted testing was needed to rule out rheumatoid arthritis. (b.) For each arthritic disability diagnosed, is it at least as likely as not (50% or greater probability) that such disorder was either incurred in or otherwise related to the Veteran’s military service? Please explain why. The examiner should address, as described above, the diagnoses of osteoarthritis, degenerative changes in the hips, and arthritic changes in the spine and multiple joints and the Veteran's statements that his STRs indicate that “his physicians wanted to rule out rheumatoid arthritis after numerous back, neck and shoulder pain complaints.” (c.) Is it at least as likely as not (a 50% or greater probability) that the Veteran’s arthritis manifested within one year of service separation? The examiner should address, as described above, the diagnoses of osteoarthritis, degenerative changes in the hips, and arthritic changes in the spine and multiple joints. (d.) As Sprengel’s deformity is considered to be a congenital “defect,” please address whether there was any additional disability due to disease or injury superimposed on the Veteran’s Sprengel’s deformity, during service. CONTINUED ON NEXT PAGE   3. If upon completion of the above action the claims remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Roe, Associate Counsel