Citation Nr: 21000431 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 13-10 260 DATE: January 5, 2021 REMANDED Entitlement to service connection for rheumatoid arthritis, to include as secondary to a service-connected disability. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from November 1976 to March 1977, May 1978 to May 1982, February 1991 to August 1991, September 2004 to April 2005, and August 2005 to September 2006. She also served in the Air Force Reserve, to include periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA). This matter is on appeal from a May 2010 rating decision and was previously remanded by the Board of Veterans' Appeals (Board) in January 2016 and March 2019. 1. Entitlement to service connection for rheumatoid arthritis. In the March 2019 remand, the Board directed that the Veteran be provided with additional VA medical opinions. The remand noted that the reviewing physician must have appropriate expertise. January 2020 VA secondary service connection opinions were provided regarding any relationship between her claimed rheumatoid arthritis and all of her service-connected disabilities (fibromyalgia, asthma with history or asthmatic bronchitis, degenerative joint disease thoracolumbar spine, right lumbar radiculopathy, hypertension, left lumbar radiculopathy and tinnitus). Negative secondary direct and aggravation opinions were provided. A January 2020 negative opinion regarding her claimed rheumatoid arthritis, as directly related to service, was additionally provided. The VA examiner provided a negative opinion, rationalizing that there was no evidence of treatment or diagnosis of rheumatoid arthritis while on active duty or within one year of separation and no mention of rheumatoid arthritis on separation examination. The examiner did not consider the Veteran’s contentions, noted in the Remand, regarding having to carry and set up heavy equipment in service and that she experienced constant vibration while flying more than 1200 hours as an aeromedical evacuation flight nurse. See September 2016 Statement. The Board finds the rationale provided in the January 2020 negative direct opinion is inadequate. While the Board regrets further delay, it finds that a remand is warranted in order to ensure substantial compliance with the March 2019 remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, in a November 2020 Written Brief Presentation, the Veteran’s representative questions the qualifications of the examiner who provided the January 2020 VA opinions. The Veteran and her representative argue that the Board’s directives expressly noted that the examination must be performed by a physician with appropriate expertise. They additionally raise issue with the secondary opinion provided with respect to any association between the Veteran’s service-connected asthma, with history of asthmatic bronchitis, and her claimed rheumatoid arthritis. A 2014 study was presented from the International Journal of Medicine which seems to indicate a relationship between the two disabilities. The representative argues that the Board should remand for an adequate medical opinion, preferably by a rheumatologist or other similarly qualified medical professional. The Board notes that VA is presumed to have properly chosen an examiner who is qualified to provide competent medical evidence, but the Veteran may challenge the competency of an examiner. In this case, the Veteran and her representative have not alleged any specific reason why the January 2020 VA examiner was not competent to provide the medical opinions; however, since the examiner’s competency has been challenged, a remand is necessary to obtain information regarding the examiner’s qualifications. See Francway v. Wilkie, 930 F.3d 1377 (2019) (holding that once a challenge to an examiner’s competency is raised, the presumption of competency is rebutted, and VA must satisfy its burden of persuasion as to the examiner’s qualifications and respond to the challenge by providing information about the qualifications of a medical examiner to the veteran). Upon remand, the RO should provide the Veteran information regarding the January 2020 VA examiner’s medical qualifications. Additionally, the Board finds that due to inadequacies in the rationale provided for the direct service connection etiological opinion an addendum direct service connection opinion should be provided. Further, because the Veteran has submitted additional evidence regarding a possible relationship between her service-connected asthma and her claimed rheumatoid arthritis, an addendum opinion which considers this medical study should be provided. The matters are REMANDED for the following actions: 1. Provide the Veteran and her representative with information regarding the qualifications of the January 2020 VA examiner, to include a curriculum vitae or other similar material and include copies of the information provided to the Veteran in the claims file. If the requested information is not obtainable, the Veteran and her representative should be notified and the reasons for such should be documented in the record. 2. Obtain an addendum opinion from a qualified examiner. An examination is not required unless deemed so by the examiner. a. Is it at least as likely as not (50 percent provability or greater) that the Veteran’s rheumatoid arthritis had its onset in, or is otherwise related to an event or injury in service (either active duty or active duty for training)? Consider and discuss the Veteran’s complaints of joint pain in service, and her contentions that she carried and set up heavy equipment and flew more than 1200 hours as an aeromedical evacuation flight nurse and experienced constant vibration that was severely detrimental to her entire body and nervous system. b. If not directly related to service, then is it at least as likely as not (50 percent probability or greater) that the Veteran’s rheumatoid arthritis was caused or aggravated beyond its natural progression by her service-connected asthma with history of asthmatic bronchitis? The medical study cited in the most recent November 2020 Written Brief Presentation should be addressed. Any opinion(s) offered should be accompanied by a clear rationale consistent with the evidence of record. If the examiner finds it impossible to provide any requested opinions without resort to speculation, he or she should so indicate and explain why such a finding is made. If opinions cannot be provided without an in-person examination, such should be scheduled. (Continued on the next page)   3. Finally, readjudicate the claim on appeal. If any of the benefits sought on appeal remain denied, then furnish the Veteran and her representative with a supplemental statement of the case and allow them an opportunity to respond. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. M. Clark, 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.