Citation Nr: 18154551 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-40 397 DATE: November 30, 2018 REMANDED Entitlement to service connection for a skin condition, claimed as eczema of the hands and knees, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to service-connected right ACL and meniscal tear is remanded. Entitlement to an initial rating in excess of 10 percent for right shoulder impingement syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2008 to April 2013. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated August 2014 of the Department of Veterans Affairs (VA) Regional Office (RO). In March 2018, the Veteran submitted a supplemental claim for service connection for posttraumatic stress disorder (PTSD). Since this claim is inextricably intertwined with the claims for anxiety and depression already on appeal, the RO forwarded the new evidence to the Board. The Board has recharacterized the issue on appeal as an acquired psychiatric disorder to reflect the diagnoses and symptoms contained in the record. The Veteran also submitted a signed form opting to participate in the Rapid Appeals Modernization Process (RAMP). However, the appeals discussed herein are not eligible for RAMP because they were active before the Board prior to VA’s receipt of the RAMP election notice form. 1. Entitlement to service connection for a skin condition claimed as eczema of the hands and knees is remanded. The Veteran seeks service connection for a skin condition claimed as eczema of the hands and knees. He has not yet been afforded a VA examination in this matter. However, the Veteran’s postservice treatment records confirm complaints of a dermatological condition on his hands. See, e.g., April 2015 VA treatment record. Further, there is a notation of skin lesions on his knees in his service treatment records (STRs). Accordingly, the Board finds that a VA examination for a medical opinion is necessary to determine whether the Veteran has a current skin condition that is etiologically related to his service. Additionally, the Board notes that on his November 2012 Pre-Discharge Compensation Claim form, the Veteran indicated he served on active duty in a combat zone since September 11, 2001. His DD Form 214 also reflects that he served at sea for more than three years and received the Global War on Terrorism Expeditionary Medal. However, there are no military personnel records or other records in the claims file to determine whether the Veteran had service in the Southwest Asia theater of operations. Notably, if such service is shown, consideration should also be given to whether the Veteran’s skin condition is a chronic undiagnosed illness. See 38 C.F.R. § 3.317. Finally, the Veteran has indicated that VA treatment records from November 2016 to the present time are pertinent to his claim. These records must be obtained for the claims file.   2. Entitlement to service connection for an acquired psychiatric disorder to include as secondary to service-connected right ACL and meniscal tear is remanded. The Veteran claims that he is suffering from an acquired psychiatric disorder which causes symptoms including anger, depression, difficulty with sleep including nightmares and dreams, and anxiety. He indicated to VA that he received mental health treatment at the Los Angeles VA Medical Center (VAMC) from November 2016 through May 2017 and Houston VAMC, Mental Health Treatment facility in Conroe, Texas from December 2017 to April 2018. Further, in his Statement in Support of Claim for PTSD dated March 2018, the Veteran indicated that his psychiatric claim was secondary to his service-connected right ACL and meniscal tear. The Board finds that VA’s duty to assist is triggered and that remand for VA treatment records and a VA medical opinion regarding entitlement to service connection on a secondary basis is warranted. 3. Entitlement to an initial rating in excess of 10 percent for right shoulder impingement syndrome is remanded. The Veteran seeks an initial rating in excess of 10 percent for his service-connected right shoulder impingement syndrome. The Veteran had a VA examination of his right shoulder disability in June 2014. Since that examination the United States Court of Appeals for Veterans Claims (Court) has clarified that examinations of musculoskeletal disabilities must comply with the language of 38 C.F.R.§ 4.59. See Correia v. McDonald, 28 Vet. App. 158, 168-70 (2016). As a result, and where applicable, VA examinations must test range of motion studies in both active and passive motion, in weight-bearing and non-weight bearing and, if possible, with range of motion measurements of the opposite undamaged joint. The June 2014 VA examination report does not comply with Correia. Accordingly, the Veteran must be afforded a new VA shoulder examination consistent with the Correia case which includes all the necessary information as set forth in 38 C.F.R.§ 4.59 The matters are REMANDED for the following actions: 1. With any necessary assistance from the Veteran and his representative, identify and obtain any outstanding VA treatment records, to specifically include his VA treatment records from November 2016; Los Angeles VAMC treatment records from November 2016 through May 2017; and Houston VAMC treatment records from December 2017 to April 2018. Any additional private treatment records identified by the Veteran should also be obtained and associated with his claims file. If such efforts yield negative results, a notation to that effect should be inserted in the file. 2. Obtain the Veteran’s military personnel file (or other pertinent records, if necessary) to determine whether he had service in the Southwest Asia theater of operations. 3. After the above records development is completed, to the extent possible, schedule the Veteran for a VA skin examination to determine the nature and etiology of his skin condition of the hands and knees claimed as eczema. After a review of the Veteran’s complete claims file including a copy of this remand, the examiner is asked to address the following: (a.) Does the Veteran have a diagnosable skin condition (which he has claimed as eczema) on his hands and/or knees? If so, for any skin condition diagnosed, is it at least as likely as not (50 percent probability or more) related to an in-service injury, event, or disease, including the skin lesions on his knees noted in his STRs. (b.) If it is established that the Veteran had service in the Southwest Asia theater of operations, the examiner is also asked to address whether the Veteran has a skin condition on his hands or his knees that is due to a (1) diagnosable chronic multi-symptom illness with a partially explained etiology, or (2) a disease with a clear and specific etiology and diagnosis? (c.) If the examiner determines that the Veteran’s disability pattern is either a diagnosable chronic multi-symptom illness with a partially explained etiology or a disease with a clear and specific etiology and diagnosis, then the examiner should opine whether it is at least as likely as not (i.e., probability of 50 percent) that the Veteran’s skin condition on his hands and his knees claimed as eczema, was incurred in service, to include as a result of his exposure to environmental hazards while serving in Southwest Asia during the Persian Gulf War? (d.) If the examiner determines that the Veteran’s disability pattern is not a diagnosable chronic multi-symptom illness with a partially explained etiology or a disease with a clear and specific etiology and diagnosis, the examiner should address whether the claimed condition is a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders. A medically unexplained chronic multi-symptom illness may include signs or symptoms such as fatigue, skin signs or symptoms, headache, muscle pain, joint pain, neurological signs or symptoms, neuropsychological signs or symptoms, upper or lower respiratory systems signs or symptoms, sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, and abnormal weight loss. 4. After the above records development is completed, to the extent possible, schedule the Veteran for a VA psychiatric examination to determine the nature and etiology of his acquired psychiatric disorder. The examiner should identify any diagnosis or diagnoses of record and offer an opinion on the following: (a.) Is it at least as likely as not (50 percent or better probability) that the Veteran’s acquired psychiatric disorder is etiologically related to his active service? (b.) Is it at least as likely as not (50 percent or better probability) that the Veteran’s acquired psychiatric disorder is caused by his service-connected right ACL and meniscal tear disability? (c.) Is it at least as likely as not (50 percent or better probability) that the Veteran’s acquired psychiatric disorder is aggravated by (worsened beyond its natural progression) by service-connected right ACL and meniscal tear disability? 5. After the above records development is completed, to the extent possible, schedule the Veteran for a VA shoulder and arm examination to assess the nature and severity of his service-connected right shoulder impingement syndrome with muscle strain. The Veteran’s complete claims file must be made available to and reviewed by the clinician in conjunction with the examination. All findings and diagnoses must be fully reported. The report should discuss the examiner’s objective evaluation for any weakened movement of the low back, excess fatigability with use, incoordination, and painful motion. (a.) Testing of the range of shoulder motion must include testing in active motion and passive motion. The examiner should also discuss weight bearing and non-weight bearing ranges if applicable. If such are not applicable, the examiner should explain why. (b.) The examiner must also address range of motion loss specifically due to pain and any functional loss during flare-ups. The examiner is asked to express an opinion on whether pain could significantly limit functional ability during flare-ups or when the joint is used repeatedly over a period of time. These determinations should, if feasible, be portrayed in terms of degrees of additional loss of range of motion due to pain on use or during flare-ups. (Continued on the next page)   (c.) If it is not feasible to provide the degrees in which there is an additional loss in range of motion during flare-ups or repeated use over time or any range of motion testing, then the clinician must provide an adequate explanation as to why. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Alexander, Associate Counsel