Citation Nr: 18123798 Decision Date: 08/03/18 Archive Date: 08/03/18 DOCKET NO. 16-15 215 DATE: August 3, 2018 ORDER Entitlement to service connection for residuals of a left wrist and hand injury is granted. Entitlement to service connection for headaches is granted. REMANDED Entitlement to service connection for musculoskeletal pain, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for dizziness, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for chronic fatigue syndrome, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for a respiratory condition, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for a sleep condition, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for an irregular heartbeat condition, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for a skin condition, to include angiolipomas, and to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for muscle twitches and hand trembles, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for memory loss and concentration issues, to include as due to Gulf War service and exposure therein is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include depression and anxiety is remanded. Entitlement to service connection for post-traumatic stress disorder (PTSD) is remanded. FINDINGS OF FACT 1. The Veteran’s service treatment records reflect he injured his left hand and wrist during training on March 3, 1985. Records also show this was during a period of inactive duty for training and the injury was incurred in the line of duty. 2. The 2014 VA examination report recorded diagnoses of a left hand sprain in 1985, a chronic left wrist sprain in 1985, and arthritis, degenerative of the left and right wrists. The Veteran reported he has had pain in his forearms and wrists for many years and it started in service when performing push-ups. 3. The 2014 examiner opined that the Veteran’s left wrist decreased range of motion and arthritis was more likely than not a progression of the injury in service. The examiner did not provide any rationale, and therefore this opinion is inadequate. 4. An additional VA opinion was obtained in February 2015. The examiner opined that it is not likely that the Veteran’s left wrist arthritis was due to a wrist injury which occurred in the military 30 years ago. However, the examiner did not address the Veteran’s statement that his pain began in service and has continued since that time. Therefore, this opinion is also considered inadequate. 5. Based upon the Veteran’s competent and credible statements during the 2014 VA examination that his pain began in service and has persisted since that time, the Board finds this it is more likely than not that the Veteran’s left wrist arthritis is related to his service. 6. The November 2014 VA examiner diagnosed the Veteran with migraines. 7. During the November 2014 VA examination the Veteran competently and credibly reported that his headaches had begun in service and continued since service. 8. The Board notes that the April 2018 medical opinion found the Veteran’s migraines were not related to service, however, the opinion did not consider the Veteran’s statements. Therefore, the Board finds the opinion to be inadequate and does not consider it probative evidence in this case. CONCLUSIONS OF LAW 1. Service connection for residuals of a left wrist and hand injury is warranted. 38 U.S.C. §§ 1110, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017 2. Service connection for migraines is warranted. 38 U.S.C. §§ 1110, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty training from June 1985 to August 1985 and on active duty from January 1991 to May 1991. In this decision, the Board has granted claims for service connection for his left wrist and hand injury and for his headaches. The reasons and bases underlying those grants are detailed in the above listed findings of fact and conclusions of law. REASONS FOR REMAND The Veteran’s active duty DD-214 reflects that he served in Southwest Asia. He applied for service connection for a skin condition, respiratory condition, sleep disorder, irregular heartbeat, migraines, chronic fatigue syndrome (CFS), musculoskeletal pain, muscle twitches and hand trembles, memory and concentration issues, dizziness, and posttraumatic stress disorder (PTSD) and an acquired psychiatric disorder The Veteran believes that his skin condition, respiratory condition, sleep disorder, irregular heartbeat, migraines, chronic fatigue syndrome (CFS), musculoskeletal pain, muscle twitches and hand trembles, memory and concentration issues, and dizziness are a medically unexplained chronic multisymptom illness that is defined by a cluster of signs or symptoms, or an undiagnosed illness. The Veteran underwent numerous VA examinations, including a Gulf War examination, for his claimed conditions in November 2014. The Gulf War examination is inadequate because it is conclusory, and does not explain how the examiner determined that the Veteran’s symptoms are not an undiagnosed illness or a medically unexplained chronic multisymptom illness. Additionally, the individual VA examinations do not discuss possible causes for the conditions noted. The Board obtained a new opinion in April 2018. However, this opinion also failed to provide an adequate rationale. The consulting expert also indicated that many of the Veteran’s symptoms may be attributable to an acquired psychiatric condition. Furthermore, the Veteran submitted a lay statement in June 2018 regarding his PTSD symptoms. Because the previous opinions provided inadequate rationales and the new PTSD statement has not been considered, new VA examinations must be obtained. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an appropriate VA examination to determine the nature and cause of ANY acquired psychiatric disorder, including PTSD, depression, and anxiety. The examiner should review the claims file (including this remand). Based on review of the record and examination of the Veteran, the examiner should provide an opinion that responds to the following: (a) Identify ALL acquired psychiatric conditions by diagnosis using the DSM-5 diagnostic criteria. The examiner should also consider the April 2018 opinion and the symptoms attributed to depression by the consulting expert. (b) For ALL diagnosed acquired psychiatric conditions, opine whether the condition is at least as likely as not (50 percent or greater probability) caused by or related to active military service or events therein. 2. After completing step 1, schedule the Veteran for VA examinations with an appropriate specialist for his skin condition, respiratory condition, sleep disorder, irregular heartbeat, chronic fatigue syndrome, musculoskeletal pain, muscle twitches and hand trembles, memory and concentration issues, and dizziness. (a) Please identify, by diagnosis, if applicable, the Veteran’s condition(s) related to a skin condition, respiratory condition, sleep disorder, irregular heartbeat, migraines, chronic fatigue syndrome, musculoskeletal pain, muscle twitches and hand trembles, memory and concentration issues, and dizziness. All pertinent diagnoses of record must be addressed. (b) Is it at least as likely as not (50 percent or greater) that the Veteran’s reported signs and symptoms regarding his claimed conditions are a medically unexplained chronic multisymptom illness that is defined by a cluster of signs or symptoms, or an otherwise undiagnosed illness? If so, please discuss any symptoms or claimed conditions that are distinct from the medically unexplained chronic multisymptom illness or undiagnosed illness. As indicated previously, the term “medically unexplained chronic multisymptom illness” means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Objective indications of a chronic disability include both “signs” in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Accordingly, the Veteran’s reports of symptoms are probative and should be considered and discussed as necessary. (c) If any of these conditions are not a medically unexplained chronic multisymptom illness, is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s condition is related to his active duty service? A detailed explanation (rationale) is required for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested.) Evan M. Deichert Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. D’Allaird, Associate Counsel