Citation Nr: 20023036 Decision Date: 04/02/20 Archive Date: 04/02/20 DOCKET NO. 14-35 619 DATE: April 2, 2020 REMANDED Entitlement to service connection for fibromyalgia is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to the non-service-connected fibromyalgia, is remanded. Entitlement to service connection for a left hip disorder, to include as secondary to the non-service-connected fibromyalgia, is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left leg groin muscle disorder is remanded. Entitlement to service connection for costochondritis (claimed as chest pain), to include as secondary to the non-service-connected heart disorder, is remanded. Entitlement to service connection for a bilateral eye disability is remanded. Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for a larynx/pharynx disability is remanded. Entitlement to service connection for a heart disorder is remanded. Entitlement to service connection for an anal disability, to include hemorrhoids, and to include as secondary to the service-connected gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS), is remanded. Entitlement to service connection for c-section residuals, to include uterus prolapse, torn cervix, and pelvic floor weakness, is remanded. Entitlement to service connection for bilateral fibrocystic breast disease (claimed as hypertrophy of breast) is remanded. Entitlement to service connection for cervical spine radiculopathy is remanded. Entitlement to service connection for sciatica of the bilateral lower extremities is remanded. REASONS FOR REMAND The Veteran had active military service from February 1989 to March 2011. These issues are on appeal from an August 2011 rating decision. The Board has recharacterized some of the issues to address potential theories of entitlement raised by the record. 1. Entitlement to service connection for fibromyalgia is remanded. 2. Entitlement to service connection for a right hip disorder, to include as secondary to the non-service-connected fibromyalgia, is remanded. 3. Entitlement to service connection for a left hip disorder, to include as secondary to the non-service-connected fibromyalgia, is remanded. 4. Entitlement to service connection for a right ankle disorder is remanded. 5. Entitlement to service connection for a left leg groin muscle disorder is remanded. 6. Entitlement to service connection for costochondritis (claimed as chest pain), to include as secondary to the non-service-connected heart disorder, is remanded. 7. Entitlement to service connection for a bilateral eye disability is remanded. 8. Entitlement to service connection for sinusitis is remanded. 9. Entitlement to service connection for a larynx/pharynx disability is remanded. 10. Entitlement to service connection for a heart disorder is remanded. 11. Entitlement to service connection for an anal disability, to include hemorrhoids, and to include as secondary to the service-connected GERD and IBS, is remanded. 12. Entitlement to service connection for c-section residuals, to include uterus prolapse, torn cervix, and pelvic floor weakness, is remanded. 13. Entitlement to service connection for bilateral fibrocystic breast disease (claimed as hypertrophy of breast) is remanded. 14. Entitlement to service connection for cervical spine radiculopathy is remanded. 15. Entitlement to service connection for sciatica of the bilateral lower extremities is remanded. The Board cannot make a fully-informed decision on the issues because no VA examiner has opined whether the Veteran’s current diagnoses are related to her active military service, to include the documented in-service notations. The record shows current diagnoses (either at the January 2011 pre-discharge VA examination or in post-service treatment records) and medical and/or lay in-service notations for all of the claims on appeal. Medical nexus opinions were not provided by the January 2011 VA examiner. Upon remand, addendum medical opinions must be obtained. Also, subsequent to the June 2014 Statement of the Case (SOC), the Agency of Original Jurisdiction (AOJ) added pertinent medical evidence to the claims file. The AOJ did not review this new evidence in the first instance. The Veteran was sent a letter in January 2020, asking if she waived initial AOJ review of this new evidence. The Veteran did not respond, and thus, in accordance with the terms of the letter, the issues are being remanded, in part, for the AOJ to review this new evidence in the first instance. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current fibromyalgia (diagnosed in October 2015) is at least as likely as not related to an in-service injury, event, or disease, including the August 2010 diagnosis of fibromyalgia. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current bilateral trochanteric bursitis of the hips is at least as likely as not related to an in-service injury, event, or disease, to include the notations of joint pain in service. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature of the Veteran’s current right ankle joint stiffness and pain. If the Veteran has a current diagnosis, then the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the June 2007 swelling of the ankle. In the event that the criteria for a diagnosis of a right ankle disorder are not met, the examiner should specifically state whether there is any functional impairment associated with the Veteran’s complaints of stiffness and pain in the right ankle. Please complete the “Functional Impact” section of the report of examination. If there is functional impairment, please offer an opinion as to whether it is at least as likely as not that such impairment is associated with the Veteran’s service, to include the June 2007 swelling of the ankle. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature of the Veteran’s current left groin pain. If the Veteran has a current diagnosis, then the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. In the event that the criteria for a diagnosis of a left groin disability are not met, the examiner should specifically state whether there is any functional impairment associated with the Veteran’s complaints of left groin pain. Please complete the “Functional Impact” section of the report of examination. If there is functional impairment, please offer an opinion as to whether it is at least as likely as not that such impairment is associated with the Veteran’s service. 5. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current costochondritis is at least as likely as not related to an in-service injury, event, or disease, including the 2008 atypical chest pain (noted in June 2010). 6. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not there was aggravation of the pre-existing myopic astigmatism and presbyopia (congenital defects) during or by her active military by a superimposed disease or injury, so as to in turn to result in an additional disability of the eyes. In providing the opinion, the examiner must address the June 2007 blurry vision and refractive error diagnoses. 7. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current sinusitis is at least as likely as not related to an in-service injury, event, or disease, including the August 2010 sinusitis diagnosis. 8. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current sore throat diagnosis is at least as likely as not related to an in-service injury, event, or disease, including the July 2008 and August 2010 sore throat diagnoses. 9. Obtain an addendum opinion from an appropriate clinician whether it is at least as likely as not there was aggravation of the pre-existing atrial septal defect (congenital defect) during or by her active military service by a superimposed disease or injury, so as to in turn to result in an additional heart disability. In forming the opinion, the examiner must address the November 2010 atrial septal defect. The examiner must also opine whether the Veteran’s current mitral regurgitation is at least as likely as not related to an in-service injury, event, or disease, including the November 2010 atrial septal defect. 10. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current hemorrhoids (diagnosed in May 2017) are at least as likely as not related to an in-service injury, event, or disease, including the August 2010 rectal pain and January 2011 hemorrhoids. The examiner should also opine whether the Veteran’s current hemorrhoids are at least as likely as not (1) proximately due to the service-connected GERD and IBS, or (2) aggravated by the service-connected GERD and IBS. 11. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current c-section residuals, to include vaginal wall prolapse and cysts in the cervix, are at least as likely as not related to an in-service injury, event, or disease, including the August 2010 pelvic floor physical therapy & in-service miscarriage and childbirth. 12. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current hypertrophy of the breast is at least as likely as not related to an in-service injury, event, or disease, including the August 2010 diagnosis of breast disorders. 13. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current cervical spine radiculopathy (diagnosed in October 2015) is at least as likely as not related to an in-service injury, event, or disease, including the August 2010 cervical spine radiculopathy diagnosis. The examiner should also opine whether the Veteran’s current cervical spine radiculopathy at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. 14. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s current bilateral meralgia paresthetica of the thighs is at least as likely as not related to an in-service injury, event, or disease, including the August 2010 tingling diagnosis. 15. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, to include a review of all of the new evidence added to the record since the June 2014 SOC. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and her representative a Supplemental SOC and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shauna M. Watkins, 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.