Citation Nr: 20007312 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 16-30 689 DATE: January 28, 2020 REMANDED Entitlement to service connection for an undifferentiated connective tissue disorder, to include myositis, is remanded. . Entitlement to service connection for Sjogren’s syndrome is remanded. REASONS FOR REMAND The Veteran had active service from November 2008 to December 2010. These matters come to the Board on appeal from an August 2014 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a January 2019 hearing. A transcript of that hearing is of record. These matters were previously before the Board in May 2019, when they were remanded for further development. The matters now return to the Board for appellate consideration. 1. Entitlement to service connection for an undifferentiated connective tissue disorder, to include myositis, and Sjogren’s syndrome is remanded. The May 2019 Board remand instructed the RO to obtain a VA medical nexus opinion to determine whether it was at least as likely as not that the Veteran has a current diagnosis of Sjogren’s syndrome that was incurred in or caused by service in consideration of the Veteran’s lay statements regarding having experienced dry eyes in service. The RO was also to obtain an opinion as to whether it was at least as likely as not the Veteran’s connective tissue disorder was incurred in or caused by service. The examiner was asked to clarify conflicting medical opinions. Specifically, a September 2016 opinion linked the Veteran’s connective tissue disorder to service. An October 2019 VA medical examiner found that the Veteran did not have a diagnosis of Sjogren’s syndrome. The examiner specifically stated that no diagnosis was warranted because there was no definitive evidence of a diagnosis of Sjogren’s syndrome in the current medical records. The examiner stated that the Veteran only had one positive RO serum test and there was no evidence of parotid enlargement. The examiner also noted that the Veteran had a negative ANA and lip biopsy. The examiner then opined that the Veteran’s claimed condition was less likely than not due to service because there was no evidence that the Veteran was seen for, diagnosed with, or complained of Sjogren’s syndrome while on active duty. The Board finds the examiner’s rationale inadequate for decision-making purposes. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The examiner’s reasoning that he cannot make a diagnosis based on the lack of a prior diagnosis is flawed. Further, the examiner’s statement that the Veteran did not complain of Sjogren’s syndrome in service does not address the Veteran’s lay statements as to symptoms experienced in service as outlined in the May 2019 Remand. The examiner’s report indicates that the Veteran experienced dry eyes since service. However, the May 2019 Remand specifically noted reports of dry eyes in service. As such, an addendum opinion is required to resolve the deficiencies outlined above. The October 2019 VA medical examiner opined that the Veteran’s undifferentiated connective tissue disorder was less likely than not incurred in or caused by service. The examiner stated that the Veteran’s in-service symptoms were acute only. The examiner further stated that the record does not show that the Veteran was diagnosed with a connective tissue disease in service, and therefore there was no nexus. The Board finds the examiner’s rationale inadequate for decision-making purposes. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The examiner does not provide adequate explanation for why the Veteran’s symptoms of an undifferentiated connective tissue disease in service were of an acute nature, nor does the opinion address the conflicting VA opinions from September 2016. The Board is unclear what symptoms found in service are being attributed to a connective tissue disorder. Further, the Board would like a greater understanding as to why those symptoms would not be related to complaints of a connective tissue disorder made shortly after service. On remand, an addendum opinion is necessary to consider the deficiencies outlined herein. The matters are REMANDED for the following action: 1. Forward the record and a copy of this remand to the examiner who completed the October 2019 VA medical opinions, or, if that examiner is unavailable, to another suitably qualified VA clinician, for completion of an addendum opinion. If necessary for an adequate opinion, the examiner may obtain another examination of the Veteran. The examiner must provide opinions as to: a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran has a current diagnosis of Sjogren's syndrome. A complete rationale must be provided for the opinion proffered. b) If yes, whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s Sjogren’s syndrome was incurred in or caused by service. A complete rationale must be provided for the opinion proffered. In rendering the requested rationale, the examiner must address the Veteran's lay statements with regard to symptoms of dry eyes related to eye treatment he received in service. c) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran has a connective tissue disorder that was incurred in or caused by service. A complete rationale must be provided for the opinion proffered. The examiner should address the Veteran’s claimed in-service symptoms and address the conflicting medical opinions provided in September 2016. The examiner should further explain why any symptoms found in service are deemed acute in nature, as appropriate. 2. After completing the above development, readjudicate the issues on appeal. If any benefit sought remains denied, issue a supplemental statement of the case and return the case to the Board. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Baker, 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.