Citation Nr: 18155001 Decision Date: 12/04/18 Archive Date: 12/03/18 DOCKET NO. 09-00 973 DATE: December 4, 2018 REMANDED Entitlement to service connection for degenerative joint disease (DJD), right shoulder is remanded. Entitlement to service connection for DJD, left wrist with limitation of motion is remanded. Entitlement to service connection for DJD, left shoulder is remanded. Entitlement to service connection for a back disorder is remanded. Entitlement to service connection for a right eye disorder is remanded. Entitlement to service connection for a gastrointestinal disorder claimed as gastritis is remanded. Entitlement to service connection for a skin disorder claimed as rash on groin is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to an increased rating for pseudofolliculitis barbae is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1966 to January 1968 and from October 1972 to July 1974. These matters come before the Board of Veterans’ Appeals (Board) on appeal from several rating decisions of the Waco, Texas, Department of Veterans Affairs (VA) Regional Office (RO). In August 2008, in pertinent part, the RO denied claims of service connection for a left wrist disability, diabetes mellitus, a lumbar spine disability, a bilateral shoulder disability, and a right eye disability. In April 2010, in pertinent part the RO denied claims of service connection for gastroenteritis and a groin rash and granted service connection for pseudofolliculitis barbae, assigning a noncompensable rating. The Veteran testified at a Board hearing in May 2013; the transcript is in the file and has been reviewed. In August 2013 the Board disposed of other decisions on appeal and remanded these remaining issues for further development. Such development has been completed and this matter is returned to the Board for further consideration. The Board further notes that the Veteran perfected an appeal of the RO’s March 2014 rating continuing a 10 percent rating for limited extension right hip, decreased an evaluation of impairment of the right hip from10 percent to 0 percent effective October 31, 2013; continued a 10 percent rating for a right knee DJD; continued a 10 percent rating for a left knee DJD and denied a compensable rating for bilateral hearing loss. He filed a notice of disagreement (NOD) in the same month; a statement of the case (SOC) was issued in October 2015 and he perfected the appeal in December 2015. The RO has yet to certify this matter for appeal and is continuing to develop evidence for this as indicated in a May 2017 SSOC. Thus, the Board shall defer consideration of these issues pending certification. The Board further notes that in August 2018 the Veteran filed a NOD with the initial rating and effective date granted for bilateral pes planus in a May 2018 rating. A SOC was issued in November 2018; a substantive appeal has yet to be received. 1. DJD, Right Shoulder is remanded. The Veteran testified to receiving VA treatment in 1993 when he was in Houston. The Board remanded this matter in August 2013 in part to obtain complete VA records, with directions to the RO to notify the Veteran of the unavailability of records it was unable to obtain. Since that remand, records from 2000 through 2018 have been obtained. However, no records from prior to 2000 were obtained, including those records from 1993 that were specifically mentioned by the Veteran. He further received no notice from the RO of the unavailability of these pre-2000 records. Further complicating this matter, since this August 2013 remand the Veteran now argues per an August 2017 Statement in Support of Claim that he has received treatment at the Houston Texas VA starting in the early 1980s, and points to the VA having not mentioned obtaining such records. Hence the development is incomplete in terms of obtaining records in VA’s constructive possession. The Board must defer consideration of this matter pending obtaining these records or confirming their unavailability. 2. DJD, Left Wrist with Limitation of Motion is remanded. The Board shall defer consideration of this matter pending obtaining VA treatment records prior to 2000 per the discussion of the remand for the right shoulder issue (issue #1). Additionally regarding the left wrist, it was the Board pointed out in its August 2013 remand that it was in disagreement with findings from a VA examiner in December 2011 that the left wrist disability clearly and unmistakably pre-existed service. The Board explained its reasons for this in detail in the remand and specifically instructed an addendum opinion that was limited to whether it is likely as not that a left wrist disorder was incurred in service. The April 2014 VA addendum opinion in its rationale again stated that a left wrist disorder pre-existed service, in direct contradiction to the Board’s August 2013 findings. Thus, the Board finds an addendum opinion should again be obtained that is strictly limited to whether a left wrist disability was incurred in service and refrain from describing the Veteran as having a preexisting condition in its rationale. 3. DJD, Left Shoulder is remanded. The Board shall defer consideration of this matter pending obtaining VA treatment records prior to 2000 per the discussion of the remand for the right shoulder issue (issue #1). 4. Back disorder is remanded. The Board shall defer consideration of this matter pending obtaining VA treatment records prior to 2000 per the discussion of the remand for the right shoulder issue (issue #1). 5. Right eye disorder is remanded. The Board shall defer consideration of this matter pending obtaining VA treatment records prior to 2000 per the discussion of the remand for the right shoulder issue (issue #1). The Veteran has further questioned the adequacy of VA examinations regarding several of his claimed disabilities in his statement in support of claim from August 2017. See VA 21-4138 entered 8/31/17. In regard to his claimed eye disorder, he states that STRs contain “measurements and other findings” pertaining to his eye examination for Worldwide duty/separation number 67 were marked NIBH, which he states indicates that he had night blindness, while elsewhere night vision was left blank. He felt that these findings coupled with constant right eye pain clearly establishes a nexus that was ignored by the VA eye examiner. Further, he now alleges that his in-service treatment for gonorrhea could be a cause of his eye issues. Hence, an addendum opinion should be obtained that addresses these allegations. 6. Gastrointestinal disorder claimed as gastritis is remanded. The Board shall defer consideration of this matter pending obtaining VA treatment records prior to 2000 per the discussion of the remand for the right shoulder issue (issue #1). The Veteran has further questioned the adequacy of VA examinations regarding several of his claimed disabilities in his statement in support of claim from August 2017. See VA 21-4138 entered 8/31/17. Regarding his claimed gastritis, he alleges that he had constant stomach problems since the military that were not adequately considered by the VA examiner in March 2010. He noted that he had diagnoses of GERD, dyspepsia and hiatal hernia and he believes these issues are related to his GI issues treated in service. He expressed that had a more adequate VA examination been given he would have been granted service connection. The March 2010 VA examination noted that the Veteran had been treated for suspected gastroenteritis in service but determined that this resolved with treatment and no chronic gastrointestinal disorder ensued. The Board notes that GERD has been listed on the problem lists and treated since as early as June 2008, and continues to be manifested through 2018. Later a December 2011 GI consult noted a history of intermittent heartburn and reflux for 40 years He has continued with a diagnosis of GERD and later GERD with hiatal hernia. . The Board finds that further examination is necessary to address whether a diagnosed gastroesophageal reflux disease (GERD) and hiatal hernia shown post-service is as likely as not related to the gastroenteritis disorder treated in service. 7. Skin disorder claimed as rash on groin is remanded. The Board shall defer consideration of this matter pending obtaining VA treatment records prior to 2000 per the discussion of the remand for the right shoulder issue (issue #1). Additionally, regarding his claimed groin rash, this matter is intertwined with his diabetes claim, as the August 2013 VA examination addendum gave an opinion that the groin rash is less likely as not related to service but is less likely as not related to service but is likely due to his diabetes mellitus and a scratch/itch cycle causing lichen simplex chronicus). See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a “significant impact” upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). Therefore, the Board finds that the diabetes claim must be adjudicated by the AOJ prior to appellate consideration of this matter. 8. Diabetes mellitus is remanded. The Board shall defer consideration of this matter pending obtaining VA treatment records prior to 2000 per the discussion of the remand for the right shoulder issue (issue #1). Regarding his claimed diabetes, the Veteran now argues per an August 2017 Statement in Support of Claim that he has received treatment for diabetes at the Houston, Texas, VA starting in the early 1980s. . Hence, the development is incomplete as such records are in VA’s constructive possession. Additionally, the Board finds that an addendum VA opinion is necessary to address whether diabetes mellitus has been or is presently being aggravated by treatment for service connected PFB, should it be determined that he has required steroid treatment for PFB. Possible aggravation of diabetes symptoms is noted in April 2015 when his blood sugar was elevated to 310 and he was noted to have trouble controlling blood sugar since using steroids that were used to treat the rash on his face diagnosed as dermatitis. See 105 pg. CAPRI received 6/3/15 at pg. 2-22. 9. Pseudofolliculitis barbae (increased rating) is remanded. Regarding his claimed PFB the Veteran was last provided a VA examination for this disorder in March 2010. Since this examination was provided, additional treatment records have been obtained, including records showing treatment in April through May 2015 for a rash of the face that was described as contact dermatitis and was treated with the steroid Prednisone. As this rash was in the same facial region as impacted by the PFB, this should be re-examined for C&P purposes. Further given that the Veteran has suggested in his hearing transcript that the PFB impacted him from a disfigurement perspective the examination should address whether any active or residual PFB has any characteristics of disfigurement, as well as whether this PFB has required any treatment with steroids. Therefore, a new VA examination is warranted. Schafrath v. Derwinski, 1 Vet. App.589 (1991); 38 C.F.R. § 3.327 (a); see Green v. Derwinski, 1 Vet. App. 121 (1991) (VA has a duty to conduct a thorough and contemporaneous examination of the Veteran in an increased rating claim); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997) (a veteran is entitled to a new examination after a two-year period between the last VA examination and the Veteran’s contention that the pertinent disability had increased in severity). The matters are REMANDED for the following action: 1. First, request all VA records for the Veteran prior to 2000, specifically to include any records from the VAMC in Houston from the early 1980s and/or early 1990s. Associate the records with the file. If unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. Return the file to the April 2014 VA examiner, or send the file to a new examiner if necessary, to determine the etiology of a left wrist disorder. The examiner is instructed to find that any remote injury prior to service had resolved. Thus, the question for consideration is whether it is at least as likely as not that a current left wrist disability was incurred in or the result of either period of active service, with no mention of aggravation to be made. Any opinions should be accompanied by a clear rationale. If the examiner cannot respond without resorting to speculation, he or she should explain why a response would be speculative. If another physical examination is deemed necessary to respond to this inquiry, then one should be arranged. 3. Schedule the Veteran for a skin disorder examination to determine the current severity of the service-connected PFB. The examiner must be provided the claims file and must review the claims file and all previous VA examination reports. The examination report should also show consideration of the Veteran’s documented medical history and assertions/complaints. All indicated studies, should be completed, and all clinical findings reported in detail. The examiner should report all pertinent findings to include any characteristics of disfigurement shown, and also make a determination whether the PFB has required any systemic therapy at any time during this appeal, to include addressing whether the treatment with Prednisone between April and May 2015 for a diagnosed dermatitis of the face constituted such treatment for the service connected PFB. Any opinions should be accompanied by a clear rationale. If the examiner cannot respond without resorting to speculation, he or she should explain why a response would be speculative. 4. If the above VA examination for the Veteran’s PFB discloses that it has required treatment with systemic therapy, including Prednisone between April and May 2015, then refer the Veteran’s VA claims file to a suitably qualified VA medical professional, for a supplemental opinion as to the etiology of the Veteran’s diabetes. If, after review of the claims file, the examiner determines that a VA examination is necessary, such must be scheduled and the Veteran must be notified. Thereafter, the examiner must address the following: The examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s diabetes was (1) caused by or (2) has been aggravated by his service-connected PFB, to include any systemic medication used to treat this disorder. Aggravation is defined as a worsening beyond the natural progression of the disease or disability. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it. The examiner must include in the examination report the rationale for any opinion expressed. 5. Return the file to the November VA examiner, or send the file to a new examiner if necessary, to provide an addendum opinion regarding the etiology of the right eye disorder. The examiner is instructed to clarify whether the Veteran’s current eye disorder is related to claimed findings of “night blindness” in the STRs as alleged in See VA 21-4138 entered 8/31/17. See 104 pg. STRs at pg. 39-40, 46-48, 50. Additionally, the examiner should address whether it is as likely as not that any current right eye disorders are related to in-service treatment for gonorrhea. Any opinions should be accompanied by a clear rationale. If the examiner cannot respond without resorting to speculation, he or she should explain why a response would be speculative. If another physical examination is deemed necessary to respond to this inquiry, then one should be arranged. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any gastrointestinal disorder, including GERD with hiatal hernia. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including suspected gastroenteritis treated in service. Any opinions should be accompanied by a clear rationale. The Veteran’s lay history of continued GI symptoms should be addressed by the examiner. If the examiner cannot respond without resorting to speculation, he or she should explain why a response would be speculative. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Eckart, Counsel