Citation Nr: 19123799 Decision Date: 03/29/19 Archive Date: 03/29/19 DOCKET NO. 17-47 854 DATE: March 29, 2019 REMANDED Entitlement to service connection for myofascial syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from January 2003 to August 2003, October 2004 to January 2006, October 2007 to January 2008 and January 2008 to October 2008. Entitlement to service connection for myofascial pain syndrome is remanded. The Veteran seeks service connection for myofascial syndrome. However, the Board finds that the record is unclear as to whether the Veteran’s claimed symptoms are due to neck or back pain. In the May 2015 notice of disagreement and September 2017 Form 9, the Veteran asserts that during service, he hurt his back in two places, upper and lower back. The Veteran is already service connected for a back disability, thoracic strain. The June 2017 VA opinion of record indicates that the Veteran’s in-service complaints of upper back pain relate to the current back disability. As the Veteran is already service connected for a back disability, the Regional Office (RO) denied the claim. However, the record reflects that the Veteran may have a neck disability, which could relate to his complaints of upper back pain. The Board notes that a Veteran is not required to link symptoms to a specific disability. A June 2017 VA neck Disability Benefits Questionnaire (DBQ) reflects a clinical diagnosis for myofascial syndrome. In the corresponding medical opinion provided, the June 2017 VA examiner opined that it is at least as likely as not that the condition is related to service. However, the examiner was referring to the thoracic strain. The examiner reasoned that after performing a physical exam and reviewing medical records, it is at least as likely as not the Veteran’s thoracic strain is related to military service. The examiner indicated that records show that the Veteran was diagnosed with backpain and thoracic sprain and treated while on active duty. The examiner further indicated that the current diagnosis of thoracic strain is at least as likely as not a result of the same upper back condition diagnosed while the Veteran was in service. However, this opinion does not address the current diagnosis for myofascial syndrome indicated in the June 2017 neck DBQ. The Board acknowledges that the June 2017 back DBQ reflects the examiner’s statements that the neck DBQ was upload in error and that the Veteran has upper back pain, not neck pain. Contrary to the June 2017 VA examiner’s assessment that the Veteran does not have neck pain, VA records reflect numerous complaints of neck pain. As such, the Board finds that a rationale is needed as to the VA examiner’s conclusion that the upper back pain in service is related to the thoracic strain and not a current neck condition. The Board acknowledges that the Veteran has only indicated that he had upper and lower back pain in service. However, as the record suggests a current neck disability, which could reasonably be construed as upper back pain given the close proximity of the neck and upper back, the Board finds it necessary to clarify whether the Veteran has a current diagnosed neck condition as well. See Savage v. Shinseki, 24 Vet. App. 259 (2011) (the Board may have a duty to seek clarification of unclear or insufficient medical opinions). The Board acknowledges that pain, by itself, is not a disability for which service connection may be granted by VA. See Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999). However, the record is unclear as to whether the Veteran’s neck pain is part of the myofascial disorder, a chronic pain disorder. Also, VA recognizes pain as a disability where there is also functional impairment. See Saunders v. Wilkie, ___ F. 3d ___, No. 2017-1466 (Fed. Cir. April 3, 2018). The June 2017 back DBQ indicates functional impairment due to pain. As it is unclear whether the Veteran’s neck was physically examined (since the DBQ was uploaded in error), the Board finds that physical examination is necessary to determine whether there is also neck pain that results in functional impairment. If it is determined that the Veteran has myofascial syndrome of the neck or neck pain resulting in functional impairment, then an opinion is necessary as to whether the neck condition is related to the Veteran’s service, to include his in-service reports of upper back pain. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate examiner to assess the nature and etiology of his neck pain. The claims file must be made available to the examiner, and the examiner should state in the opinion that review of the electronic record was accomplished. The examiner is asked to review all pertinent records associated with the claims file and any assertions made by the Veteran regarding his symptoms. The examiner is advised that the Veteran is competent to attest to observable symptoms, such as pain. If there is a medical basis to support or doubt the Veteran’s reports of symptomatology, the examiner should provide a fully reasoned explanation. i) Initially, the examiner is asked to physically examine the Veteran and indicate whether he has a current neck disability, to include myofascial syndrome. ii) If the above answer is negative, the examiner is asked to physically examine the Veteran and provide an assessment as to whether his neck pain results in functional impairment. If so, the examiner is advised that the neck pain accompanied by functional impairment is sufficient to indicate a diagnosis for VA purposes. iii) If a diagnosis is rendered for the neck, the examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent probability of greater) that the neck was pain was incurred during, caused by or is otherwise related to the Veteran’s active service. Importantly, the examiner must consider the Veteran’s reports of upper back pain in service and whether those symptoms may relate to a neck disability instead. 2. After completing the above actions, readjudicate the claim on appeal. If the benefits sought on appeal remain denied, the Veteran should be furnished an appropriate Supplemental Statement of the Case and be provided an opportunity to respond. Thereafter, the case should be returned to the Board for further appellate consideration, as appropriate. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (West 2012). GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Smith, Associate Counsel