Citation Nr: 18152958 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 16-42 099 DATE: November 27, 2018 REMANDED Entitlement to service connection for joint pain, to include as due to an undiagnosed illness, is remanded. Entitlement to service connection for a right shoulder disorder is remanded. Entitlement to service connection for a left shoulder disorder is remanded Entitlement to service connection for a back disorder is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. REASONS FOR REMAND The Veteran had active military service from August 1986 to September 1992. This matter is on appeal from December 2015 and February 2017 rating decisions. 1. Entitlement to service connection for joint pain, to include as due to an undiagnosed illness is remanded. The Board of Veterans’ Appeals (Board) cannot make a fully-informed decision on the issue of service connection for joint pain. The Veteran was provided a VA examination in October 2016. Normal hip, elbow, and neck evaluations were noted, and the examiner opined that the Veteran's knee, hip and shoulder complaints were mechanical and unrelated to Gulf War exposures. However, no rationale for the negative nexus was provided. Furthermore, as noted in her August 2016 substantive appeal, the Veteran has also contended that her joint complaints are due to the rigors of service. In light of this, remand is necessary for a new examination. 2. Entitlement to service connection for right and left shoulder disorders is remanded. The Board cannot make a fully-informed decision on the issue of service connection for a bilateral shoulder disorder. A December 2016 VA examination shows that the Veteran identified relevant outstanding private treatment records. A remand is required to allow VA to obtain authorization and request these records. 3. Entitlement to service connection for a back disorder is remanded. The Board cannot make a fully-informed decision on the issue of service connection for a back disorder. A December 2016 VA examination shows that a negative nexus opinion was provided; however, the examiner indicated that the question was not clear regarding whether a preexisting back injury was aggravated by service. The opinion as provided is not adequate; therefore, a remand is required to obtain a new medical opinion. 4. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Board cannot make a fully-informed decision on the issue of service connection for an acquired psychiatric disorder. VA examinations were obtained in October 2015 and November 2017. Both examiners opined that the Veteran had a preexisting psychiatric disorder prior to service. However, neither opinion was provided in the correct clear and unmistakable evidentiary standard. Therefore, these opinions are not adequate and a remand is required to obtain a new medical opinion. The matters are REMANDED for the following action: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran, including any outstanding VA treatment records and from private physicians, including those seen for her bilateral shoulders. 2. Accord the Veteran a VA orthopedic examination, with a medical professional of appropriate expertise who has reviewed the claims file, to determine the nature, extent, and etiology of any joint, bilateral shoulder, and back disorders. The most up-to-date Disability Benefits Questionnaire(s) should be utilized. The examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed joint, bilateral shoulder, and back disorders are related to the Veteran’s military service. If no known clinical diagnosis can be made for one or more of these disorders, please opine whether there are nonetheless signs and symptoms which are chronic in nature (i.e., an “undiagnosed illness”). A complete rationale should be given for all opinions and conclusions expressed. The examiner should consider the Veteran’s reports in her February 2016 notice of disagreement that her disorders are due to the rigors of service, including carrying a heavy ruck sack. For the Veteran’s back, the examiner is requested to review the record and offer opinions as to the following: (a) Is there clear and unmistakable evidence (obvious, manifest, and undebatable) that any currently diagnosed back disorder preexisted the Veteran’s active service (August 1986 to September 1992). (b) If so, state whether there is clear and unmistakable evidence that the preexisting back disorder was NOT aggravated (i.e., permanently worsened) during service; or whether, it is clear and unmistakable that any increase in service was due to the natural progress of the disorder. (c) If a back disorder is NOT found to clearly and unmistakably exist prior to the Veteran’s service, the examiner should opine as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed back disorder is related to the Veteran’s service. 3. Accord the Veteran a VA psychiatric examination, with a medical professional of appropriate expertise who has reviewed the claims file, to determine the nature, extent, and etiology of any acquired psychiatric disorder. The most up-to-date Disability Benefits Questionnaire(s) should be utilized. The examiner is requested to review the record and offer opinions as to the following: (d) Is there clear and unmistakable evidence (obvious, manifest, and undebatable) that any currently diagnosed acquired psychiatric disorder preexisted the Veteran’s active service (August 1986 to September 1992). (e) If so, state whether there is clear and unmistakable evidence that the preexisting acquired psychiatric disorder was NOT aggravated (i.e., permanently worsened) during service; or whether, it is clear and unmistakable that any increase in service was due to the natural progress of the disorder. (f) If an acquired psychiatric disorder is NOT found to clearly and unmistakably exist prior to the Veteran’s service, the examiner should opine as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed acquired psychiatric disorder is related to service. The examiner should consider the Veteran's treatment in October 1987 for suicidal ideation. A complete rationale should be given for all opinions expressed. A.C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Barstow, Counsel