Citation Nr: 18144086 Decision Date: 10/23/18 Archive Date: 10/23/18 DOCKET NO. 16-15 821A DATE: October 23, 2018 REMANDED Entitlement to service connection, to include on a secondary basis, for costochondritis is remanded. REASONS FOR REMAND The Veteran’s served on active duty from February 1968 to January 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by a Department of Veterans Affairs Regional Office (RO). 1. Costochondritis The Veteran asserts entitlement to service connection for costochondritis. Specifically, the Veteran asserts that his costochondritis resulted from an in-service pugil stick injury. In this regard, the Board notes that an October 1967 STR shows the Veteran was treated for a fractured left 9th rib. The Veteran underwent a VA general medical examination in October 2012 during which the examiner noted a diagnosis for costochondritis. No medical opinion was provided. Another VA examination report was issued in February 2013 during which the Veteran reported being hit with a pugil stick during service that broke and cracked his ribs. The Veteran described his condition as arthritis of the inner lining of his rib cage. The examiner also noted a diagnosis for non-Hodgkin’s lymphoma which was discovered as a result of a lump found on the center of the Veteran’s chest. The Veteran reported that his tumor had “fingers” that had extended throughout his thoracic rib cage. Additionally, the Veteran reported that the location of the tumor was the same location he was hit with a pugil stick. The examiner opined that the diagnosed costochondritis was “less likely than not (less than 50 percent probability)” incurred in or caused by the service-connected non-Hodgkin’s lymphoma. In support of this opinion, the examiner found that a relationship between the costochondritis and the non-Hodgkin’s lymphoma could not be found. No medical opinion as to direct service connection was provided. Since the February 2013 VA examination, additional medical records show that in June 2015, the Veteran was diagnosed of costochondritis “related to an injury he received in service.” An October 2015 VA psychiatric medical record noted various ailments related to the Veteran’s exposure to presumed exposure to dioxin, including diabetes and non-Hodgkin’s lymphoma, which led to a vitamin D deficiency resulting in the development of costochondritis. The Veteran had been prescribed vitamin D3 supplements as recommended by his physician. Finally, an April 2016 private medical record noted a diagnosis for costochondritis as a result of trauma to the chest which was further noted as occurring during service between 1967 and 1970. After a review of the evidence of record, the Board finds that a new VA examination is necessary to adequately adjudicate the issue on appeal. Specifically, the Board finds the October 2012 and February 2013 VA examinations inadequate as neither provided an etiological opinion as to direct service connection. Additionally, while the February 2013 VA examiner found no relationship between the costochondritis and the non-Hodgkin’s lymphoma, subsequent VA medical records have asserted such a relationship. VA medical records have additionally noted a possible relationship with the Veteran’s service-connected diabetes. Accordingly, a new VA examination is required. The matter is REMANDED for the following action: 1. With any necessary identification of sources by the Veteran, request all VA treatment records not already associated with the file from the Veteran’s VA treatment facilities, and all private treatment records from the Veteran not already associated with the file. 2. Then, schedule the Veteran for an examination by an appropriate examiner to determine the nature and etiology of his diagnosed costochondritis. The examiner should provide the following opinions: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed costochondritis is etiologically related to his period of service? (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed costochondritis was caused by a service-connected disability, to include diabetes and non-Hodgkin’s lymphoma? Please explain why or why not. (c) Is it at least as likely as not (50 percent or greater probability) that any diagnosed costochondritis was permanently worsened beyond normal progression (aggravated) by a service-connected disability, to include diabetes and non-Hodgkin’s lymphoma? Please explain why or why not. If the examiner finds that the disability was aggravated by a service-connected disability, the examiner must identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. The examiner should review pertinent documents in the Veteran’s claims file in connection with the examination including this Remand. The examiner should discuss any conflicting evidence of record. All indicated studies should be completed. Reasons should be provided for any opinion rendered. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Lamb, Associate Counsel