Citation Nr: 21002625 Decision Date: 01/14/21 Archive Date: 01/14/21 DOCKET NO. 16-18 640 DATE: January 14, 2021 REMANDED Service connection for a skin rash is remanded. Service connection for muscle pain is remanded. Service connection for sleep problems is remanded. Service connection for gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the United States Army from September 1975 to September 1995. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran attended a videoconference hearing before the undersigned in March 2019. In August 2019, the Board issued a decision denying service connection for a skin rash, muscle pain, sleep problems, and GERD. In an August 2020 Order, the United States Court of Appeals for Veterans Claims (Court) endorsed a joint motion for partial remand (JMPR), vacated the Board’s August 2019 decision, and remanded the case for further action consistent with the terms of the joint motion. As noted above, this matter was returned to the Board pursuant to an August 2020 JMPR. “A joint motion for remand, when drafted properly, identifies … clear instructions to the Board as to what it is required to address, and what actions it is required to take, on remand. This increases both administrative and judicial efficiency.” Carter v. Shinseki, 26 Vet. App. 534, 541 (2014), vacated on other grounds sub nom. Carter v. McDonald, 794 F.3d 1342 (Fed. Cir. 2015). Skin Rash The Board cannot make a fully-informed decision on the issue of service connection for a skin rash because no VA examiner has opined whether the Veteran’s skin rash is related to chemical exposure while in the Persian Gulf. A remand is necessary to obtain a VA examination. Muscle Pain Sleep Problems GERD In January 2015, the Veteran underwent a VA Gulf War General Medical Examination. The examiner opined that the “Veteran’s disability pattern/s are diseases with clear and specific etiology and diagnosis and are not related to any exposures during service.” The examiner though did not specify which disability pattern he is referring to, nor did he specify what the “clear and specific etiology and diagnosis” are. The Board finds the examination to be inadequate and a remand is necessary to obtain a new examination. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from July 2020 to the Present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s skin rash. The claims file should be made available to the examiner. The examiner must opine with complete rationale whether it is at least as likely as not (50 percent or greater) that the Veteran’s skin rash are related to chemical exposures while in the Persian Gulf. A complete rationale must be provided. 3. Schedule the Veteran for an appropriate examination to determine the nature and etiology of his condition, to include muscle pain and sleep problems. The examiner must review the entire claims file, including a copy of this remand. The examiner should conduct all appropriate diagnostic testing. The examiner should then record all noted signs and reported symptoms, document all clinical findings, and provide a diagnosis if possible. The examiner is asked to provide responses to the following: A) Identify the Veteran’s objective indications of a disability. “Objective indications” of a qualifying chronic disability include both objective evidence perceptible to an examining physician and other non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Non-medical indicators include evidence such as time lost form work, the veteran having sought treatment for his symptoms, and change in the veteran’s appearance, physical abilities, and mental or emotional attitude. 60 Fed. Reg. 6661, 6663 (Feb. 3, 1995). B) By history, physical examination, or laboratory testing, can the Veteran’s objective indications of a disability be attributed to a known clinical diagnosis? If the signs and symptoms are not characteristic of a known clinical diagnosis, the examiner should so indicate. There is no requirement that the examiner provide a diagnosis of undiagnosed illness. C) If the Veteran’s objective indications cannot be attributed to a known clinical diagnosis, is there affirmative evidence that the undiagnosed illness is not incurred during active service during the Persian Gulf War or that it was caused by a supervening condition or event that occurred since the Veteran’s departure from service during the Persian Gulf War? The examiner should note that a positive response to this question requires affirmative evidence. The mere absence of evidence is not sufficient. D) If the Veteran’s objective indications can be attributed to a known clinical diagnosis, is the etiology of the Veteran’s condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran’s specific case and cannot be based on the etiology of the disease or disability population as a whole. E) If the Veteran’s objective indications can be attributed to a known clinical diagnosis, is the pathophysiology of the Veteran’s condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran’s specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. F) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s diagnosed condition was incurred in, or is otherwise related to, his active service? A complete rationale must be provided for all opinions expressed. 4. Schedule the Veteran for an examination to determine the nature and etiology of his GERD. The examiner must review the entire claims file, including a copy of this remand. The examiner is asked to provide responses to the following: A) Is the etiology of the Veteran’s GERD (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the etiology of the disease or disability population as a whole. B) Is the pathophysiology of the Veteran’s GERD (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. C) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s GERD was incurred in, or is otherwise related to, his active service? A complete rationale must be provided for all opinions expressed. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael Chandeck, 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.