Citation Nr: 21066231 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 16-07 075 DATE: October 29, 2021 REMANDED Entitlement to service connection for lupus is remanded. Entitlement to service connection for fibromyalgia, claimed as myalgia arthritis, and is remanded. Entitlement to service connection for visual disturbances is remanded. Entitlement to service connection for chronic respiratory problems, to include chronic cough, shortness of breath, and chronic bronchitis, is remanded. Entitlement to service connection for chronic fatigue syndrome is remanded. Entitlement to service connection for Raynaud's syndrome is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from January 1991 to November 1991. This matter is on appeal from a May 2014 rating decision. In May 2021, the Veteran's attorney withdrew the Veteran's request for a hearing before a Veterans Law Judge. The claims for entitlement to service connection for lupus, fibromyalgia, claimed as myalgia arthritis, visual disturbances, chronic respiratory problems, to include chronic cough, shortness of breath, and chronic bronchitis, chronic fatigue syndrome, and Raynaud's syndrome are remanded. The Veteran contends that her lupus, diagnosed in 2011, and other claimed disorders began during her active duty from January 1991 to November 1991. Since the April 2014 VA examination for respiratory disorders, which included an opinion on lupus, the Veteran has submitted several years worth of additional private medical records that the VA medical opinion provider was unable to consider. The Veteran has also submitted a September 2021 private medical opinion by Dr. M.B.S., as well as other opinions, but the opinions also did not consider all the medical evidence of record. As such, the Board finds a new VA medical opinion is necessary to address the contention that lupus developed during service. In his September 2021 private medical opinion, Dr. M.B.S. found that the Veteran's Raynaud's and respiratory issues, were due to lupus. He implied that the Veteran's vision disturbances and joint pain are also due to lupus, stating that an in-service eye complaint and joint pain was evidence of lupus starting in service. He found that the Veteran did not have fibromyalgia, but did have chronic broncitis that started in service. Medical opinions are necessary to address these issues as no VA medical opinion has addressed them. The Board also notes that none of the medical opinions addressed the Veteran's contention that her disorders developed due to vaccinations received during service, made in an August 2013 lay statement. As the Veteran contentions indicate that her Raynaud's and respiratory disorders may have developed secondary to her claimed lupus, a decision on lupus could significantly impact a decision on the other service connection claims. The issues are inextricably intertwined and a remand of is required. 7. Entitlement to a TDIU is remanded. Finally, because a decision on the remanded issues could significantly impact a decision on TDIU, the issues are inextricably intertwined. A remand of TDIU is required. The Veteran has contended to have been unemployable since 2013 to 2017, and to only be able to work since 2017 due to her work accommodations. Given the extended period of reported unemployability, the AOJ should verify whether there are any outstanding Social Security Administration (SSA) records related to her reported period of unemployability. The matters are REMANDED for the following actions: 1. Obtain the Veteran's federal records from SSA, if such records exist. Document all requests for information as well as all responses in the claims file. 2. After record development has been accomplished, obtain a VA medical opinion from a physician with experience with autoimmune disorders, for the issues of entitlement to service connection for (a) lupus, (b) fibromyalgia, claimed as myalgia arthritis, (c) visual disturbances, (d) chronic respiratory problems, to include chronic cough, shortness of breath, and chronic bronchitis, (e) chronic fatigue syndrome, and (f) Raynaud's syndrome. If a VA examination is deemed necessary to form an opinion on any claimed disorder, one should be obtained for the disorder(s) in question. The VA medical opinion provider must review the claim file. The VA medical opinion provider is asked to provide a response to the following: Does the Veteran have a current diagnosis of (a) lupus, (b) fibromyalgia, claimed as myalgia arthritis, (c) visual disturbances, (d) chronic respiratory problems, to include chronic cough, shortness of breath, and chronic bronchitis, (e) chronic fatigue syndrome, and/or (f) Raynaud's syndrome? Please clarify each diagnosed disorder. Is (a) lupus, (b) fibromyalgia, (c) visual disturbances, (d) chronic respiratory problems, (e) chronic fatigue syndrome, and/or (f) Raynaud's syndrome at least as likely as not related to service (from January to November 1991), including contentions that symptoms developed during service or developed due to vaccinations? See August 2013 lay statement, September 2021 private medical opinion from Dr. M.B.S. Regarding the lupus, did the disorder develop within one year of her separation from service (from January to November 1991)? In providing the requested opinion, consider the Veteran's description of her in-service injury and symptoms as well as her post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of her current disability, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? If lupus is found to have developed during service (from January to November 1991) or within one year of separation from service, is (b) fibromyalgia, (c) visual disturbances, (d) chronic respiratory problems, (e) chronic fatigue syndrome, and/or (f) Raynaud's syndrome at least as likely as not proximately due to OR aggravated, i.e., worsened beyond its natural progression by lupus? A fully articulated medical rationale for any opinion expressed must be set forth in the medical report. The VA medical opinion provider should discuss the particulars of this Veteran's medical history and relevant medical science as applicable to this case, which may reasonably explain the medical guidance in the study of this case. The full claim file should be reviewed, to include (i) the September 2021 private medical opinion of Dr. D.M.S., (ii) the February 2016 private medical opinion of J.A.C., DNP, (iii) the April 2014 VA examination, (iv) the June 2013 private DBQ of Dr. D.A.F., (v) the private medical records [such as the Highland Hospital records received in November 2016 (one entry labelled as correspondence and one as medical treatment record), records from Dr. D. and Dr. F. (incorrectly labelled with service treatment records received August 2013), and Rainbow River Medical records], (vi) service treatment records (from January to November 1991), (g) any lay statements such as one from August 2013, and (f) any additional records obtained, such as from SSA. 3. If upon completion of the above requested development the issues remain denied, the appeal should be returned to the Board after compliance with appellate procedure. E.I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Lindio 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.