Citation Nr: 18150397 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-40 606A DATE: November 15, 2018 REMANDED Entitlement to service connection for joint pain, to include as due to an undiagnosed illness or other qualifying chronic disability pursuant to 38 U.S.C. § 1117, is remanded. Entitlement to service connection for dizziness, to include as due to an undiagnosed illness or other qualifying chronic disability pursuant to 38 U.S.C. § 1117, is remanded. Entitlement to service connection for fatigue, to include as due to an undiagnosed illness or other qualifying chronic disability pursuant to 38 U.S.C. § 1117, is remanded. Entitlement to service connection for fibromyalgia, to include as due to an undiagnosed illness or other qualifying chronic disability pursuant to 38 U.S.C. § 1117, is remanded. Entitlement to service connection for memory loss, to include as due to an undiagnosed illness or other qualifying chronic disability pursuant to 38 U.S.C. § 1117, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1982 to August 1992, to include service in the Southwest Asia. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. On May 16, 2018, the Veteran elected to participate in VA’s Rapid Appeals Modernization Program (RAMP), selecting the option for “Supplemental Claim.” Given that appeals that have been activated by the Board are not eligible for RAMP processing, and the present issues were activated by the Board in February 2017, prior to the Veteran’s election to participate in RAMP, the Board will proceed with their adjudication pursuant to current appeals procedures. The Veteran contends that the claimed disabilities manifest by joint pain, dizziness, fatigue, fibromyalgia, and memory loss are undiagnosed illnesses or other qualifying chronic disabilities. See November 2013 Claims. He has also claimed that the claimed disabilities are related to his exposure to environmental hazards coincident with his service in Southwest Asia, reported as “driving through oil fires and areas marked hazardous.” See April 2014 Gulf War Disability Benefits Questionnaire (DBQ) report. As the Veteran had documented service in Southwest Asia Theater of Operations, see Form DD 214, consideration of 38 U.S.C. § 1117(a)(1) (2012) for objective indications of a qualifying chronic disability is warranted. Entitlement to service connection for joint pain and fibromyalgia are remanded. With regard to the claimed joint pain, an April 2014 Gulf War DBQ examiner generally opined that “no disability pattern respective to Gulf War service was found,” but the opinion was otherwise unresponsive to the pertinent questions for consideration of the provisions under 38 C.F.R. § 3.317, and the examiner failed to render a nexus opinion specific to the claimed joint pain. Further, it is unclear whether the April 2014 DBQ examiner considered various reports of chronic joint pain, documented in the Veteran’s private pain management treatment records, to assess whether such evidence indicates objective indications of a qualifying chronic disability. See, e.g., March 2017 private pain management treatment record (noting chronic pain in the cervical spine, forearms, and hands). A remand is necessary for a VA Gulf War examination for an addendum addressing these deficiencies. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As for the claimed fibromyalgia, the April 2014 Gulf War DBQ examiner found that the Veteran had no diagnosis of fibromyalgia, yet it is unclear whether the examiner considered private treatment records noting that the Veteran has “history of fibromyalgia [that] was diagnosed 2 years [ago],” although no actual diagnosis is currently of record. See January 2017 private pain management treatment record. A remand is necessary for a VA Gulf War examination for an addendum addressing this deficiency. Entitlement to service connection for dizziness, fatigue, and memory loss are remanded. The April 2014 Gulf War DBQ examiner opined that the claimed fatigue, dizziness, and memory loss were “historical symptoms and [were] not specific to a single diagnosis and may be attributed to a mental health condition or hormonal condition as well as a plethora of other clinically plausible conditions . . . .” In doing so, the April 2014 DBQ examiner failed to discern whether these “symptoms . . . not specific to a single diagnosis” indicated undiagnosed illnesses without any known clinical diagnoses, or whether these symptoms had known diagnoses, which were potentially caused or aggravated by the Veteran’s service-connected posttraumatic stress disorder (PTSD) and depression. Further, it is unclear whether, or to what extent, the “historical symptoms” relevant to the claimed dizziness, fatigue, and memory loss are manifestations of or separate from the service connected psychiatric disability. A remand is necessary for a VA Gulf War examination for an addendum addressing these deficiencies. Specific to the claimed dizziness, if such is attributed to a known clinical diagnosis, the addendum should address whether the claimed disability is related to the Veteran’s various in-service reports of dizziness and headaches. See November 1988 service treatment record (noting a report of headaches, nausea, and dry heaving); November 1988 service treatment record (noting another report of headaches and vomiting although no abnormalities were present at that time); January 1989 service treatment record (noting a report of dizziness and nausea). Further, pertinent to all claims, the Veteran has contended that the April 2014 Gulf War DBQ report is inadequate because the examiner failed to consider his currently prescribed medications, to include Sertraline, Amitriptyline, Meloxicam, and Trolamine Salicylate, for claimed conditions. See August 2016 Substantive Appeal (via VA Form 9). In the April 2014 DBQ reports, the examiner checked “no” as to whether the Veteran required continuous medication for the claimed conditions, which suggests that her opinion may have been based on an inaccurate factual basis. See, e.g., Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The addendum opinions should address this deficiency on remand. The matters are REMANDED for the following action: 1. Update the Veteran’s private and VA treatment records. 2. Afford the Veteran a VA Gulf War examination from an appropriate examiner, other than the April 2014 DBQ examiner, addressing the claimed disabilities manifest by joint pain, fibromyalgia, fatigue, dizziness, and memory loss. Any indicated evaluations, studies, and tests should be conducted. (A) The examiner should note and detail all reported symptoms of the claimed disabilities manifest by joint pain (other than joint pain from the service-connected right shoulder disability), fibromyalgia, fatigue, dizziness, and memory loss. The examiner should conduct a comprehensive general medical examination, and provide details about the onset, frequency, duration, and severity of all such symptoms. (B) The examiner should specifically state whether the Veteran’s claimed disabilities manifest by joint pain (other than joint pain from the service-connected right shoulder disability), fibromyalgia, fatigue, dizziness, and/or memory loss are attributed to known clinical diagnoses. (C) If any symptoms associated with the claimed disabilities manifest by joint pain (other than joint pain from the service-connected right shoulder disability), fibromyalgia, fatigue, dizziness, and/or memory loss are not determined to be associated with known clinical diagnoses, the examiner should indicate whether the Veteran has objective indications of a chronic disability resulting from an undiagnosed illness, as established by history, physical examination, and laboratory tests, that has either (1) existed for 6 months or more, or (2) exhibited intermittent episodes of improvement and worsening over a 6-month period. In this regard, the examiner should consider reports of chronic joint pain, documented in the Veteran’s private pain management treatment records, to assess whether such evidence indicates objective indications of a qualifying chronic disability. See, e.g., March 2017 private pain management treatment record (noting chronic pain in the cervical spine, forearms, and hands). The examiner should also consider the private treatment records referencing a history of fibromyalgia. With regard to the claimed fatigue, dizziness, and memory loss, the examiner should also consider the April 2014 Gulf War DBQ examiner’s finding that claimed fatigue, dizziness, and memory loss were “historical symptoms and [were] not specific to a single diagnosis and may be attributed to a mental health condition or hormonal condition as well as a plethora of other clinically plausible conditions.” The examiner should then opine whether and/or to what extent the symptoms attributable to such finding are manifestations of or separate from the Veteran’s service-connected disabilities, to include PTSD with depression and tinnitus. Finally, as for all claimed disabilities, the examiner should consider the Veteran’s report that he is currently prescribed medications, to include Sertraline, Amitriptyline, Meloxicam, and Trolamine Salicylate, for all claimed conditions. See August 2016 Substantive Appeal (via VA Form 9). (D) For each known clinical diagnosis, the examiner should render an opinion as to whether it is at least as likely as not (i.e. a 50 percent or greater probability) that such disorder is related to the Veteran’s military service, to include exposure to environmental hazards coincident with his service in Southwest Asia, reported as “driving through oil fires and areas marked hazardous.” Specific to the claimed dizziness, if such is attributed to a known clinical diagnosis, the examiner should address whether the claimed disability is related to the Veteran’s various in-service reports of dizziness and headaches. See November 1988 service treatment record (noting a report of headaches, nausea, and dry heaving); November 1988 service treatment record (noting another report of headaches and vomiting although no abnormalities were present at that time); January 1989 service treatment record (noting a report of dizziness and nausea). A complete rationale for any opinion offered should be provided. 3. After completing the above actions, to include any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claims should be readjudicated based on the entirety of the evidence. If the claims remain denied, the Veteran and his representative should be issued a Supplemental Statement of the Case. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Kim, Associate Counsel