Citation Nr: 21067238 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 16-51 575 DATE: November 3, 2021 REMANDED Entitlement to service connection for rheumatoid arthritis and osteoarthritis of the bilateral upper extremity other than the bilateral hands is remanded. Entitlement to service connection for type II diabetes mellitus is remanded. REASONS FOR REMAND The Veteran had active military service from November 1958 to June 1962 and from July 1964 to March 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from December 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2019, the Veteran testified at a Board hearing. A transcript of the hearing is of record. By way of background, in January 2020, the Board granted the Veteran's petition to reopen his claim for entitlement to service connection for type II diabetes mellitus and remanded the claim for further evidentiary development. Then, in July 2020, the Board denied the claim for entitlement to service connection for rheumatoid arthritis and osteoarthritis of the bilateral upper extremities but granted the claim for entitlement to service connection for arthritis of the bilateral hands. The Veteran appealed the decision to the U.S. Court of Appeals for Veterans Claims (Court). In August 2021, the Court partially vacated the Board decision and remanded the appeal for further proceedings. 1. Entitlement to service connection for rheumatoid arthritis and osteoarthritis of the bilateral upper extremity other than the bilateral hands is remanded. At the outset, a November 2017 private medical treatment record reflects a diagnosis of rheumatoid arthritis. See July 2019 Medical Treatment Record Non-Government Facility. A review of the service treatment records (STRs) shows that the Veteran was diagnosed with rheumatoid arthritis. In the June 1958 enlistment examination and March 1962 separation examination he was noted to have normal upper extremities with no rheumatic fever, swollen or painful joints, arthritis, rheumatism, or painful or trick shoulder or elbow. See July 2012 STR Medical. Again, in the May 1964 enlistment examination he was noted to have normal upper extremities with no rheumatic fever, swollen or painful joints, arthritis, rheumatism, or painful or trick shoulder or elbow. Then, in a January 1965 STR, he complained of swelling of the left wrist for two to three months and swelling of the right wrist. An x-ray scan of the wrist revealed negative findings and yet he was diagnosed with possible arthritis. In a May 1968 re-enlistment examination, he was noted to have normal upper extremities. In a March 1969 STR, it was noted that based on the records with documented effusions and episodes of pain along with family history of rheumatoid arthritis, the examiner felt that the Veteran's condition was probably rheumatoid arthritis. See July 2012 STR Medical. In an April 1972 periodic examination, he exhibited normal upper extremities. See July 2012 STR Medical. In a January 1973 latex test, it was determined that the quantity was insufficient, but it was noted that he was positive for rheumatoid arthritis. See July 2012 STR Medical. In a November 1973 STR, he was diagnosed with mild rheumatoid arthritis. In a January 1975 STR, it was noted that laboratory data was compatible with rheumatoid arthritis. In a September 1978 STR, he requested a permanent profile due to his rheumatoid arthritis. In a May 1979 periodic examination, he had mild rheumatoid arthritis in his wrist. In a December 1980 STR, he was diagnosed with rheumatoid arthritis of the left shoulder. In a May 1981 STR, he was diagnosed with possible rheumatoid arthritis of the bilateral hands. In the April 1982 retention examination and in a February 1983 STR, he was diagnosed with mild rheumatoid arthritis of the hands. Then, in an April 1984 STR, the Veteran was provided a provisional diagnosis of rheumatoid arthritis of the bilateral upper extremities. It was further noted that there was no rheumatoid arthritis factor in his chart. Shortly thereafter, in a September 1984 STR, he was diagnosed with bursitis and/or arthritis. In the December 1986 separation examination, he was noted to have swollen or painful joints and rheumatoid arthritis. A June 1987 x-ray scan of the right shoulder and hand revealed no abnormalities. The post STR shows that in a January 1998 blood test, he was negative for rheumatoid factor. See May 2019 Medical Treatment Record Government Facility. However, in an April 2017 private treatment record, he was noted to have a past medical history of rheumatoid arthritis. See July 2019 Medical Treatment Record Non-Government Facility. The Board acknowledges the multiple VA examinations associated with the file. For instance, in the January 1998 VA examination of the joints, the examiner noted that x-ray scans of the bilateral shoulders and wrists were normal. In the December 2003 VA examination, the examiner stated that he has a known history of thoracic outlet syndrome which remains unchanged. He was diagnosed with bilateral thoracic outlet syndrome and osteoarthritis of the bilateral hands. In the January 2020 VA examination, the examiner determined that the Veteran did not have a current diagnosis of rheumatoid arthritis. The examiner conceded that rheumatoid as a possibility was noted in STRs, but never confirmed. The examiner determined that no rheumatoid arthritis has ever been objectively diagnosed or treated. He explained that the 1998 blood test showed negative results for rheumatoid factor. The JMR noted that it is unclear how the VA examiner determined that rheumatoid arthritis was a possibility as noted in the STRs but never confirmed when the STRs shows a positive rheumatoid arthritis test result. The Board finds that a remand is warranted for an addendum opinion. 2. Entitlement to service connection for type II diabetes mellitus is remanded. The Board finds that a remand is required so that the RO may re-adjudicate the claim and issue the Veteran a Supplemental Statement of the Case (SSOC) for the Veteran's claim for entitlement to service connection for diabetes mellitus. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records. 2. Thereafter, obtain an addendum opinion from an appropriately qualified examiner to determine the nature and etiology of his rheumatoid arthritis and osteoarthritis of the bilateral upper extremities. The claims file, including a copy of this remand, must be made available to be reviewed by the examiner. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran's rheumatoid arthritis and/or osteoarthritis of the bilateral upper extremities had its onset in service or is otherwise etiologically related to service. The examiner should consider the following history: In a May 1968 re-enlistment examination, he was noted to have normal upper extremities. In a March 1969 STR, it was noted that based on the records with documented effusions and episodes of pain along with family history of rheumatoid arthritis, the examiner felt that the Veteran's condition was possibly rheumatoid arthritis. In an April 1972 periodic examination, he exhibited normal upper extremities. In a January 1973 latex test, it was determined that the quantity was insufficient, but that he was positive for rheumatoid arthritis. In a November 1973 STR, he was diagnosed with mild rheumatoid arthritis. In a January 1975 STR, it was noted that laboratory data was compatible with rheumatoid arthritis. In a September 1978 STR, he requested a permanent profile due to his rheumatoid arthritis. In a May 1979 periodic examination, he had mild rheumatoid arthritis in his wrist. In a December 1980 STR, he was diagnosed with rheumatoid arthritis of the left shoulder. In a May 1981 STR, he was diagnosed with possible rheumatoid arthritis of the bilateral hands. In the April 1982 retention examination and in a February 1983 STR, he was diagnosed with mild rheumatoid arthritis of the hands. Then, in an April 1984 STR, the Veteran was provided a provisional diagnosis of rheumatoid arthritis of the bilateral upper extremities. It was further noted that there was no rheumatoid arthritis factor in his chart. Shortly thereafter, in a September 1984 STR, he was diagnosed with bursitis and/or arthritis. In the December 1986 separation examination, he was noted to have swollen or painful joints and rheumatoid arthritis. A June 1987 x-ray scan of the right shoulder and hand revealed no abnormalities. The Board would appreciate if the examiner explained whether rheumatoid arthritis can be detected on an x-ray scan, and whether the worsening of rheumatoid arthritis can cause osteoarthritis. It would also be beneficial if the examiner can explain whether a person can have both rheumatoid arthritis and osteoarthritis. The examiner should also note whether a blood test that shows negative rheumatoid factor is a gold standard in determining whether a person does not have rheumatoid arthritis. A detailed rationale for all opinions must be provided. 3. The RO must issue a SSOC as to the Veteran's claims on appeal, to include the claim for diabetes mellitus, before returning the case to the Board. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Noh, 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.