Citation Nr: 21062607 Decision Date: 10/08/21 Archive Date: 10/08/21 DOCKET NO. 17-26 618 DATE: October 8, 2021 REMANDED Entitlement to service connection for rheumatoid arthritis, claimed as arthritis of the right hand, elbow, and shoulder, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1967 to February 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In his May 2017 substantive appeal, the Veteran requested a Board hearing by live videoconference. However, in August 2021, he advised that he no longer wanted a Board hearing, thus, withdrawing his request for a hearing. 38 C.F.R. §§ 20.702 (e), 20.704(e). The Board also notes that following issuance of the April 2017 supplemental statement of the case, new VA medical records were received in the file. However, the relevant evidence in the new VA medical records is duplicative of information that was in the record at the time the April 2017 supplemental statement of the case was issued, so a waiver of agency of original jurisdiction (AOJ) review is not necessary. 38 C.F.R. § 19.37; 38 U.S.C. § 7105(c). The Veteran contends that he is entitled to service connection for his arthritis because he suffered a shrapnel injury to his right hand and shoulder during his service in Vietnam and that is when the arthritis began. The Veteran has been service connected for multiple fragment wounds of the right hand index finger, radial aspect, which is rated as neuritis of the right median nerve. The Veteran also contends that his arthritis is secondary to his service connected right median nerve disability. Entitlement to service connection for arthritis is remanded While the Board regrets the additional delay, the Veteran's claim of entitlement to service connection for arthritis must be remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The service treatment records show that the Veteran suffered multiple fragment wounds of the right hand and abrasions of the skin of the right shoulder. The Veteran was afforded a VA arthritis examination in June 2015, and it was requested that an opinion regarding service connection for arthritis secondary to the service-connected condition related to the right median nerve be provided. The examiner acknowledged a diagnosis of rheumatoid arthritis. The Veteran reported that he was diagnosed with rheumatoid arthritis around 1991 and that he received medical treatment since that time. The examiner opined that the Veteran's arthritis is less likely than not proximately due to or the result of the Veteran's service-connected multiple fragment wounds of the right hand index finger, radial aspect. The rationale provided stated that the Veteran has a diagnosis of rheumatoid arthritis that developed decades after his military service ended. Thus, finding that the condition is separate from and not caused by or aggravated beyond the natural progress by the Veteran's former shrapnel injury involving his right upper extremity while in service. The Board finds the June 2015 VA arthritis examination opinion to be inadequate. The examiner's opinion is wholly based upon a lack of medical evidence showing a diagnosis prior to 1991. However, a lack of evidence cannot be corroborating to conclude that there is no relationship between the Veteran's current disability and his military service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Moreover, the examiner included no further medical analysis in providing the rationale for the opinion. The examiner did not thoroughly discuss why, on a medical basis, the Veteran's right median nerve injury would not have at least as likely as not led to, or aggravated, his arthritis. The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion." See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that "a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor's opinion"). Furthermore, based upon the fact that the Veteran sustained a significant shrapnel injury to his hand and shoulder during his service in Vietnam, an opinion regarding direct service connection between the injury sustained in service and the Veteran's arthritis should have been provided. A medical opinion is inadequate when it does not consider all raised theories of entitlement. See Stefl, 21 Vet. App. 120 (2007). The Veteran has stated, "I was wounded in Vietnam and that is when the arthritis started in my right hand and right shoulder." See VA Form 9, May 17, 2017. In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran's statement regarding the chronicity of his arthritis has not been considered. Additionally, the Veteran stated that he received a diagnosis of rheumatoid arthritis in 1991 and that he has received medical care for his arthritis ever since. However, the medical records in the case file only go back to March 2010. Therefore, potentially relevant private or VA medical records regarding the treatment of the Veterans arthritis are not of record. No attempt to obtain such records is documented in the case file. The VA has the duty to make reasonable efforts to assist a claimant in securing evidence necessary to substantiate their claim for VA benefits. See 38 U.S.C. § 5103, 5103A; 38 C.F.R. § 3.159(c). Accordingly, remand is warranted for further development. The matters are REMANDED for the following action: 1. The AOJ must assist the Veteran in procuring any relevant VA and private medical records that have not yet been associated with the claims file. The AOJ must provide the Veteran with the proper authorization forms for release of information and ask the Veteran to complete the forms in order that VA may assist the Veteran in obtaining the records. The AOJ must provide the Veteran with the appropriate period of time to complete and return the authorization forms. If the initial request for such information is not responded to, the AOJ must issue a follow-up request. Upon receipt of authorization by the Veteran to obtain the relevant medical records, the AOJ must make reasonable efforts, at least two (2) attempts, to obtain the relevant records. All attempts to secure the relevant medical evidence must be documented in the claims file, and if, after exhausting efforts to obtain the records, they are not able to be secured and it is determined that they do not exist or that further attempts would be futile, the AOJ must provide the Veteran and his representative the required notice and opportunity to respond. 2. After completing the foregoing development, the Veteran should be scheduled for an examination with an appropriate VA clinician, preferably a specialist, for the issuance of a medical opinion as to the nature and etiology of his rheumatoid arthritis. Any evaluations, studies, or tests deemed necessary by the examiner should be accomplished and any such results must be included in the examination report. Based on the examination and review of the record, the examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's arthritis was incurred in or caused by his military service. Based on the examination and review of the record, the examiner is also asked to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's arthritis was caused OR aggravated by the Veteran's service-connected right median nerve disability (multiple fragment wounds of the right hand index finger, radial aspect). The examiner is advised that the term "aggravation" is defined for legal purposes as a chronic worsening of the underlying condition beyond its natural progression. In providing the opinions the examiner must consider and discuss the Veteran's statement that the arthritis started in his right hand and right shoulder after his injury in Vietnam. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. The examiner must provide a complete rationale for any opinion expressed. If the examiner is unable to reach an opinion without resort to speculation, he or she should explain the reasons for this inability and comment on whether any further tests, evidence, or information would be useful in rendering an opinion. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Temple, 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.