Citation Nr: 21065437 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 15-04 747 DATE: October 26, 2021 REMANDED The claim of entitlement to service connection for rheumatoid arthritis is remanded. The claim of entitlement to service connection for an allergy disability is remanded. The claim of entitlement to service connection for asthma is remanded. The claim of entitlement to eligibility for specially adapted housing is remanded. The claim of entitlement to eligibility for financial assistance for automobile and adaptive equipment, or adaptive equipment only, is remanded. The claim of entitlement to special monthly compensation (SMC) based on the need for aid and attendance (A&A) is remanded. The claim of entitlement to a temporary total disability rating is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from November 1987 to January 1991. The instant matter is on appeal from an August 2014 rating decision. Most recently, the Board remanded these issues in order to conduct additional evidentiary development, to include obtaining VA examinations to assess the etiologies of the disabilities on appeal. 1. The claim of entitlement to service connection for rheumatoid arthritis, an allergy disability, and asthma are remanded. Initially, the Board notes that the Veteran's service treatment records may be incomplete. While she requested a discharge due to pregnancy in 1990, there is no separation examination associated with the claims file, nor is there an indication that she waived a separation examination in her discharge proceedings. Thus, the Regional Office should ensure that the Veteran's complete service treatment records, including those generated while she served overseas in Germany, have been obtained and associated with the claims file. Additionally, remand is necessary in order to obtain addendum medical opinions addressing the claimed disabilities on appeal. The Board previously remanded for VA examinations in October 2020, which were conducted in June 2021. Unfortunately, the opinions provided in the examination reports do not provide supportive rationales, and either do not address lay evidence of record or discount it without explanation. By way of example, the examination report states that the Veteran's reports of ongoing allergies are "subjective only" and thus there is no evidence of chronicity of care. While the Board is not assigning credibility to the Veteran's lay statements herein, the examiner must explain why these subjective reports are insufficient to sustain a nexus opinion. The Veteran has also provided lay statements from herself and her family discussing ongoing symptoms related to the disabilities on appeal that remain unaddressed in their entirety by the present VA examination reports. Accordingly, remand is necessary in order to obtain more thorough addendum opinions regarding the disabilities on appeal. 2. The claim of entitlement to eligibility for specially adapted housing, eligibility for financial assistance for automobile and adaptive equipment, or adaptive equipment only, SMC based on A&A, and a temporary total disability rating are remanded. With regard to the remaining claims on appeal, the Board finds that these issues are inextricably intertwined with the resolution of the remanded issues. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to defer the claim on appeal pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). Accordingly, these issues are remanded for readjudication following evidentiary development. The matters are REMANDED for the following action: 1. Ensure that all service treatment records have been associated with the claims file. If not, attempt to obtain, through all indicated and appropriate sources, any outstanding service treatment records. All efforts to obtain these records should be documented. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile. This determination should be documented in the claims file and the Veteran must be notified. 2. Obtain any relevant, outstanding VA treatment records that are not already associated with the claims file. If no records are available, the claims folder must indicate this fact and the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). All attempts to contact the Veteran should be documented in the record. 3. Once the aforementioned development is complete, obtain a medical opinion from a new examiner, if possible, to address the etiology of the Veteran's claimed allergy disability. A new examination may be ordered if deemed necessary by the examiner. The examiner must consider the Veteran's lay statements regarding observable symptomatology both during and after service. After a thorough review of the medical and lay evidence of record, the examiner should discuss the following: (a.) Based upon the medical and lay evidence of record, is there clear and unmistakable evidence (such that reasonable minds could not differ) that any allergy condition preexisted active duty service? To note: The Veteran subjectively reported hay fever on her May 1987 entrance examination. (b.) If you determine that an allergy condition clearly and unmistakably preexisted service, was it clearly and unmistakably not aggravated (i.e., not permanently worsened beyond the natural progression of the disease) during service? Specifically discuss the Veteran's lay statements of observable symptoms during service. (c.) If it is found that there is clear and unmistakable evidence that the Veteran's allergy condition existed prior to service AND that there is clear and unmistakable evidence that the condition was not aggravated by service, please clearly indicate the basis/evidence supporting your conclusions. (d.) If the Veteran's allergy condition did not preexist service OR it was not aggravated by service, please then opine as to whether it is at least as likely as not (i.e., a probability of 50 percent or more) that the Veteran's allergy condition is etiologically related to her active duty service? (e.) The examiner is asked to specifically address lay statements of record related to readily observable symptomatology associated with the claimed disability. If such symptoms cannot establish a nexus, the examiner should provide a thorough rationale as to why. The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 4. Once the aforementioned development is complete, obtain an addendum opinion from a new examiner, if possible, to assess the etiology of the Veteran's asthma. A complete copy of the claims file must be provided to the examiner, including a copy of this remand. The examiner must consider lay reports of observable symptomatology. After a thorough review of the record, the examiner should opine as to the following: (a.) Is it at least as likely as not (i.e., a probability of 50 percent or more) that the Veteran's asthma had its onset during active service or within one year of separation from service, or, otherwise resulted from active military service? (b.) The examiner is asked to specifically discuss lay statements of record pertaining to observable symptomatology associated with her asthma. If such symptoms cannot establish a nexus, the examiner should provide a thorough rationale as to why. The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 5. Once the aforementioned development is complete, obtain an addendum opinion from a new examiner, if possible, to assess the etiology of the Veteran's rheumatoid arthritis. A complete copy of the claims file must be provided to the examiner, including a copy of this remand. The examiner must consider lay reports of observable symptomatology. After a thorough review of the record, the examiner should opine as to the following: (a.) Is it at least as likely as not (i.e., a probability of 50 percent or more) that the Veteran's rheumatoid arthritis had its onset during active service or within one year of separation from service, or, otherwise resulted from active military service, to include as due to the in-service reaction to vaccinations? To note: it is insufficient to summarily state that rheumatoid arthritis is unrelated to the in-service leukemoid reaction. A rationale must be provided. The examination report should specifically state that a review of the record was conducted. The examiner should provide a complete rationale for all opinions provided. If an opinion cannot be provided without to resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. 6. Following completion of the foregoing, the AOJ should review the record and readjudicate the claims on appeal. If any remain denied, the AOJ should issue an appropriate supplemental SOC, afford the Veteran and her representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Fisher, 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.