Citation Nr: 18149125
Decision Date: 11/08/18	Archive Date: 11/08/18

DOCKET NO. 16-36 634
DATE:	November 8, 2018
REMANDED
1. Entitlement to service connection for right shoulder acromioclavicular (AC) joint arthropathy, to include as due to an undiagnosed illness, is remanded.
2. Entitlement to a total disability rating based on individual unemployability due to service-connected disability (TDIU) is remanded.
REASONS FOR REMAND
The appellant is a Veteran who served on active duty from May 1987 to February 1993.  These matters are before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision. 
The issues of service connection for joint pain (to include ankles and knees) and pharyngitis were also on appeal.  An August 2016 rating decision granted service connection for undiagnosed illness related to widespread pain with related fatigue and sore throat and assigned a 20 percent rating effective March 28, 2016.  Accordingly, the issues of service connection for joint pain (to include ankles and knees) and pharyngitis are no longer on appeal before the Board.


1. Service connection for right shoulder AC joint arthropathy (claimed as due to an undiagnosed illness).
On April 2013 VA shoulder examination, the Veteran reported that his joints started bothering him around 1993 (shortly after his discharge from service) and that the pain has since fluctuated between intermittent and chronic.  He took Naproxen until he developed gastric issues.  No opinion was provided, and service connection for a right shoulder disability was denied essentially on the basis that there was a clear diagnosis for the disability that did not represent a multi-symptom illness that would be considered due to toxic exposure during the Gulf War.  The report of examination did not contain acknowledgement, commentary, or discussion of the Veteran’s reports of the continuity of his right shoulder symptoms after service.  Therefore, remand for examination and an adequate medical advisory opinion is necessary to address the etiology of the Veteran’s right shoulder disability. 
2. Entitlement to a TDIU rating.
The matter of entitlement to a TDIU rating is inextricably intertwined with the claim being remanded, and consideration of that matter must be deferred pending resolution of the remaining claim.
The matters are REMANDED for the following:
1.  Arrange for an orthopedic examination of the Veteran to determine the nature and likely etiology of his right shoulder disability, to include whether it is directly related to (was incurred during) his service.  The Veteran’s record must be reviewed by the examiner in conjunction with this examination.  The examiner should provide opinions that respond to the following:
(a) Identify (by diagnosis) each right shoulder disability found (or shown by the record during the pendency of the instant claim).  
(b) Identify the likely etiology for each right shoulder disability entity diagnosed.  Specifically, is it at least as likely as not (a 50% or greater probability) that such disability was incurred in service?  The rationale should acknowledge (reflect consideration of) the Veteran’s statements on the April 2013 VA shoulder examination report regarding chronic joint pain since 1993. 
(c) If the opinion is to the effect that a right shoulder disability was not incurred in service, please identify the etiology considered more likely.
The examiner must include rationale with all opinions, citing to supporting factual data as deemed appropriate.
2.  Review the TDIU claim considering the determination on the service connection claim.
 
GEORGE R. SENYK
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Bayles, Associate Counsel