Citation Nr: 20074986 Decision Date: 11/24/20 Archive Date: 11/24/20 DOCKET NO. 18-24 728 DATE: November 24, 2020 REMANDED 1. Entitlement to service connection for hyperthyroidism, to include as due to an undiagnosed illness or other qualifying chronic disability, is remanded. 2. Entitlement to service connection for finger joint pain, to include as due to an undiagnosed illness or other qualifying chronic disability, is remanded. 3. Entitlement to a restoration of a 10 percent disability rating for pseudofollicular barbae (PFB), including whether the reduction in rating from 10 percent to noncompensable effective November 25, 2016 was proper, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1982 to September 2002, which included service in Southwest Asia. These matters come before the Board of Veterans’ Appeals (Board) on appeal from multiple rating decisions. The Board notes that the Veteran’s Notices of Disagreement regarding the reduction of his rating of PFB indicated that he was disagreeing with the effective date of the assigned (i.e. reduced) rating. The Board infers that the Veteran intended to appeal the reduction of his PFB ratings from a 10 percent rating to a noncompensable rating and not seek an earlier effective date for the reductions. As such, the Board has restyled the issue on the title page. The Veteran appealed to the Board of Veterans’ Appeals (Board), which partially denied the issues, in July 2019. The Veteran then appealed to the Court of Appeals for Veterans’ Claims (CAVC). In a May 2020 Order—and pursuant to a Joint Motion for Partial Remand (JMPR), CAVC set aside the Board’s July 2019 decision and remanded the issues to the Board. The deficiencies identified within the parties’ May 2020 JMPR are addressed below. 1. Entitlement to service connection for hyperthyroidism, to include as due to an undiagnosed illness or other qualifying chronic disability, is remanded. In the May 2020 JMPR, the parties agreed that VA duty to assist was not satisfied because a September 2016 VA etiology opinion regarding the Veteran’s hypothyroidism is inadequate. Notably, the VA examiner was asked to examine the Veteran for any chronic disability pattern and explain whether any such disability pattern was an undiagnosed illness, a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, a diagnosable chronic multi-symptom illness with a partially explained etiology, or a disease with a clear and specific etiology and diagnosis. The examiner stated that “[t]he Veteran’s disability pattern is a disease with a clear and specific etiology and diagnosis” without identifying the etiology of the disability pattern. In Stewart v. Wilkie, 30 Vet. App. 383, 392 (2018), the Court found an etiology opinion inadequate because the examiner failed to address the etiology or pathophysiology of the condition. Given the above, a remand is necessary to obtain a new etiology opinion. 2. Entitlement to service connection for finger joint pain, to include as due to an undiagnosed illness or other qualifying chronic disability. Additionally, within the May 2020 JMPR, the parties agreed that the Board’s prior finding that the Veteran did not have a current diagnosis associated with any claimed condition of his right finger did not adequately address indications in an August 2014 VA examination that the Veteran’s finger joint pain caused “decreased manual dexterity, problems with lifting and carrying, fatigue, [and] pain.” In Saunders v. Wilkie, 866 F.3d 1356, 1363 (Fed. Cir. 2018), the Court held that pain causing a functional impairment in earning capacity can constitute a disability under 38 U.S.C. § 1110. Therefore, the August 2014 VA examination is inadequate, and remand is warranted for an adequate opinion that properly addresses whether a disability exists under 38 U.S.C. § 1110, even despite the lack of a diagnosis. 3. Entitlement to a restoration of a 10 percent disability rating for pseudofollicular barbae (PFB), including whether the reduction in rating from 10 percent to noncompensable effective November 25, 2016 was proper. Finally, in the May 2020 JMPR, the parties further agreed that in affirming the reduction of the Veteran’s disability rating for PFB, the Board relied on a November 2016 VA examination that found “no symptoms associated with” PFB. Although the November 2016 VA examination did find that the Veteran had no “visible skin conditions,” it also found that the Veteran had post inflammatory hyperpigmentation secondary to [PFB] and that the skin condition was of “mild-moderate severity.” Given this internal inconsistency within the November 2016 VA examination, the Boar finds that a new VA examination is warranted upon remand. The matters are REMANDED for the following action: 1. Return the claims file to the VA examiner who provided the September 2016 VA examination and opinion to determine the nature and etiology of the Veteran’s hyperthyroidism. If the September 2016 VA examiner is unavailable, an equally qualified examiner may be substituted. The claims file should be made available to the examiner and reviewed in conjunction with the examination. All necessary tests and studies should be conducted, and if the examiner deems that an in-person VA examination is warranted, schedule the Veteran for a full VA examination. The examiner is asked to opine whether it is at least as likely as not (50% or greater probability) that the Veteran’s hyperthyroidism was caused by events in service or is related to the Veteran’s service. The examiner is advised that the opinion should also identify, to the extent possible, the etiology of the Veteran’s hypothyroidism disability pattern. 2. Return the claims file to the VA examine who provided the August 2014 VA examination for an addendum opinion regarding the nature and etiology of the Veteran’s claimed finger disability. If the August 2014 VA examiner is unavailable, an equally qualified examiner may be substituted. The claims file should be made available to the examiner and reviewed in conjunction with the examination. All necessary tests and studies should be conducted, and if the examiner deems that an in-person VA examination is warranted, schedule the Veteran for a full VA examination. The examiner is asked to opine whether it is at least as likely as not (50% or greater probability) that any finger disability was caused by events in service or is related to the Veteran’s service. In providing the above opinion, the examiner is asked to particularly consider that the Veteran’s reported finger joint pain caused “decreased manual dexterity, problems with lifting and carrying, fatigue, [and] pain.” In Saunders v. Wilkie, 866 F.3d 1356, 1363 (Fed. Cir. 2018), the Court has held that pain causing a functional impairment in earning capacity can constitute a disability under 38 U.S.C. § 1110. Therefore, any opinion must properly address whether a disability exists under 38 U.S.C. § 1110, even despite the lack of a formal diagnosis. 3. Return the claims file to the VA examine who provided the November 2016 VA examination for an examination regarding the nature and severity of the Veteran’s pseudofollicular barbae (PFB). If the November 2016 VA examiner is unavailable, an equally qualified examiner may be substituted. The claims file should be made available to the examiner and reviewed in conjunction with the examination. All necessary tests and studies should be conducted. (Continued on the next page)   The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the relevant rating criteria, including the percentage of the entire body and the exposed area affected by the Veteran’s PFB. The examiner should also indicate whether intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs are required and, if so, for how long during the past 12 months. Additionally, the examiner should resolve the November 2016 VA examiner’s apparently inconsistent findings that the Veteran had “no symptoms associated with” PFB and no “visible skin conditions” but that the Veteran had post inflammatory hyperpigmentation secondary to PFB that was of “mild-moderate severity. D. C. JOHNSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Edward G. Lent 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.