Citation Nr: 20055331 Decision Date: 08/20/20 Archive Date: 08/20/20 DOCKET NO. 16-30 689 DATE: August 20, 2020 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. This matter comes 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. This matter was previously before the Board in May 2019 and January 2020, when it was remanded for further development. The matter now returns to the Board for appellate consideration. The issue of entitlement to service connection for an undifferentiated connective tissue disorder, to include myositis, is no longer before the Board, as a June 2020 RO decision granted the full benefit sought on appeal. 1. Entitlement to service connection for Sjogren’s syndrome is remanded. The January 2020 Board Remand directed the RO to obtain an addendum opinion with regard to whether the Veteran had a current diagnosis of Sjogren’s syndrome and if so, whether it was related to service. A resulting January 2020 VA addendum opinion stated that it was less likely than not that the Veteran’s claimed condition was incurred in or caused by service. The examiner noted that there was no definitive evidence of a diagnosis of Sjogren’s syndrome in the medical records, and no diagnosis of Sjogren’s syndrome was given on the October 2019 VA examination. The examiner did, however, provide a positive nexus opinion for the Veteran’s claimed undifferentiated connective tissue disease. In February 2020, the examiner provided another opinion, which asked VA to disregard the previous opinion from January 2020, as it was in error. The examiner checked a box indicating that it was at least as likely as not that the Veteran’s claimed Sjogren’s syndrome was incurred in or caused by service. As rationale, the examiner stated that after an additional review of records, the Veteran was diagnosed with connective tissue disease in December 2011, within a year of separation. It was also stated that there was no diagnosis of Sjogren’s syndrome found in the medical records and that a lip biopsy on February 27, 014 had been negative for Sjogren’s. The Board is unclear as to the meaning of the examiner’s February 2020 addendum opinion. The examiner’s opinion does not address the previously unestablished diagnosis of Sjogren’s syndrome, or why the diagnosis of connective tissue disease alters the prior opinion. An addendum opinion is necessary to clarify the examiner’s conflicting statement’s with regard to whether the Veteran has a diagnosis of Sjogren’s syndrome that is related to service. The matters are REMANDED for the following action: 1. Forward the record and a copy of this remand to the examiner who completed the January 2020 and February 2020 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. (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. If the examiner who conducted the February 2020 addendum opinion is available, the examiner should clarify whether or not the February 2020 addendum opinion is meant to convey the examiner’s belief that the Veteran has a diagnosis of Sjogren’s syndrome and that the condition is related to service. A complete rationale must be provided for the opinion proffered. 2. After completing the above development, readjudicate the issue on appeal. If the 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. Harrison Baker, 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.