Citation Nr: 20007233 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 15-44 806 DATE: January 28, 2020 REMANDED Entitlement to service connection for rheumatoid arthritis is remanded. Entitlement to service connection for hypertension, to include as secondary to rheumatoid arthritis, is remanded. REASONS FOR REMAND The Veteran served with the Air Force, Air National Guard, and Army National Guard at various points from between March 1999 to November 2009. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. Addressing the relevant procedural history, these claims were previously before the Board in July 2018 at which time the Board denied both claims. The Veteran appealed the Board’s denial to the Court of Appeals for Veterans Claims (the Court). In a July 2019 Order, the Court granted a July 2019 Joint Motion for Partial Remand (JMR) signed by both parties and remanded the claims to the Board for action consistent with the terms of the JMR. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. §§ 7107(a)(2). 1. Entitlement to service connection for rheumatoid arthritis is remanded. While the record contains contemporaneous VA examinations regarding the Veteran’s asserted rheumatoid arthritis, neither examination is sufficient in lieu of the July 2019 JMR. In the JMR, the parties agreed that the Board erred when it relied on the December 2014 and October 2016 VA examinations to deny service connection for rheumatoid arthritis, both of which were agreed to be inadequate. The December 2014 VA examiner made a notation that suggested the Veteran’s claimed condition could be medically identified to some degree before the date of the formal diagnosis, but also relied on the date of diagnosis and did not explain why that date was relevant. Thus, the parties agreed that the examiner’s rationale did not support the conclusion. Further, while the examiner addressed the issue of whether the condition was due to environmental hazards in Southwest Asia, the examiner did not address whether the condition began in service, to specifically include whether the Veteran’s current condition is related to his in-service elbow and knee pain. The October 2016 VA examiner impermissibly ignored the Veteran’s lay assertions concerning the occurrence of an in-service injury, to include his assertions that he had both knee and elbow pain following his deployment to Kuwait, which was before he fell while deployed to Germany. The examiner did not sufficiently consider these lay assertions, and therefore, this examiner was also deemed inadequate. Based on the foregoing, the Board cannot make a fully-informed decision on the issue of the Veteran’s rheumatoid arthritis until the Veteran is afforded a new VA examination on remand. 2. Entitlement to service connection for hypertension, to include as secondary to rheumatoid arthritis, is remanded. The Board’s directive regarding the Veteran’s service connection claim for rheumatoid arthritis that is being remanded could potentially have an impact regarding the hypertension issue which the Veteran is, in part, claiming is secondary to his rheumatoid arthritis. Therefore, the issue of service connection for hypertension is inexplicably intertwined with the issue being remanded and the Board cannot make a fully-informed decision on the issue of the Veteran’s hypertension claim until the development outlined above is completed. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (the adjudication of claims that are inextricably intertwined is based upon the recognition that claims related to each other should not be subject to piecemeal decision-making or appellate litigation). The matters are REMANDED for the following actions: 1. Obtain all outstanding VA and private medical records pertinent to the issues on appeal. 2. Thereafter, schedule the Veteran for a VA examination before an appropriate examiner to determine the nature and etiology of the Veteran’s claimed rheumatoid arthritis. The entire claims file, including a complete copy of this remand, should be made available to and be reviewed by the clinician, and it should be confirmed that such records were available for review. The examiner must identify all impacted areas of the Veteran’s body as well as identify any functional limitations/impairment the Veteran experiences. The VA examiner is additionally asked to opine: Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s rheumatoid arthritis is related to an in-service injury, event, or disease, to specifically include his 1) in-service anthrax vaccinations, 2) in-service environmental hazards, and 3) in-service elbow and knee pain (including following his deployment to Kuwait, prior to his fall while deployed to Germany). An explanation must be provided for all conclusions reached. As part of his or her rationale, the examiner is specifically asked to address, and reconcile to the extent possible, the lay statements made by the Veteran regarding his in-service injuries and his present-day assertions that his current condition is a continuation of those issues. The examiner must also consider and reconcile any conflicting medical evidence or opinions of record. DELYVONNE M. WHITEHEAD Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Smith, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.