Citation Nr: 21069709 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 14-06 925 DATE: November 19, 2021 REMANDED Entitlement to service connection for left shoulder disability is remanded. Entitlement to service connection for bilateral knee disability is remanded. Entitlement to service connection for chronic fatigue syndrome, to include as secondary to obstructive sleep apnea is remanded. Entitlement to service connection for a sinus disability is remanded. Entitlement to service connection for chronic bronchitis is remanded. Entitlement to service connection for a left ankle disability is remanded. REASONS FOR REMAND The Veteran had active naval service from October 1986 to October 1990. This case initially came before the Board of Veterans' Appeals (Board) on appeal from a November 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. In April 2018, the Veteran and his daughter testified before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In July 2018 and April 2021, the Board remanded the claims to the Agency of Original Jurisdiction (AOJ) for additional development. The case has since been returned to the Board. The Veteran also appealed the issue of entitlement to service connection for asthma. In an August 2021 rating decision, the AOJ granted service connection for that disability, which constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Thus, that matter is no longer in appellate status. 1. Bilateral knee, left shoulder, left ankle, sinus, and chronic bronchitis. The Board finds that additional development is warranted before the remaining claims on appeal are decided. VA examinations were conducted in August 2020. It was noted that the Veteran reported that he was diagnosed with bilateral degenerative arthritis of the shoulders, bilateral ankle, and bilateral knee strain and degenerative arthritis in approximately 1987. However, the VA examiner did not provide an opinion regarding the etiology of the Veteran's disabilities. Therefore, the Board remanded the appeal to obtain a VA medical opinion. A VA medical opinion was obtained in August 2021. The examiner opined that the Veteran's bilateral knee, left shoulder, left ankle, sinus, and chronic bronchitis disabilities were less likely than not incurred in or caused by an in-service illness, event, or injury. In so finding, the examiner stated that a review of the Veteran's medical record does not show support that the disabilities were related to service. The examiner specified that the claimed sinus disability and chronic bronchitis were not related to in-service treatment for an upper respiratory infection and reports of a dry nonproductive cough during service. However, the examiner did not provide any further rationale. The Veteran provided an October 2021 letter from his private physician's assistant. The physician's assistant stated that based on the longevity of the Veteran's chronic pain, she believed the Veteran's bilateral knee pain, left shoulder pain, right shoulder pain, and left ankle pain correlated with the time frame he was enlisted in the service. In so finding, she stated that after discussions with the Veteran that she believed that the Veteran suffered minor injuries to those areas while in service. The Board finds that the private opinion and VA opinions are inadequate to decide the Veteran's claim. In this regard, the August 2021 VA examiner did not provide any rationale for her opinion. Further, the October 2021 private physician's assistant did not fully explain her rationale as the opinion does not adequately explain the relationship between the Veteran's current symptoms and his in-service disorders. Further, there is no evidence that she reviewed the Veteran's claims file. Thus, another opinion should be obtained. 2. Chronic fatigue The Veteran was afforded a VA examination for his claimed chronic fatigue syndrome in August 2021. The examiner opined that the Veteran's claimed condition was less likely than not incurred in or caused by the Veteran's claimed in-service injury, event, or illness. In that regard, the examiner found that the Veteran did not meet the criteria for a diagnosis of chronic fatigue syndrome at that time. However, the examiner did not address the previous diagnoses of chronic fatigue. Specifically, the Board notes that the Veteran's private treatment records reflect diagnoses of chronic fatigue and chronic fatigue syndrome during the appeal period. Thus, a new opinion should be obtained. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for VA examinations by examiner(s) with sufficient expertise to determine the nature and etiology of the Veteran's bilateral knee, left shoulder, left ankle, sinus, and chronic bronchitis disabilities. The examiner(s) should review the claims file and indicate that review in the report. Any indicated studies should be performed. Based upon the examination results and a review of the record, the examiner(s) should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any bilateral knee, left shoulder, left ankle, sinus, and chronic bronchitis is etiologically related to service. As the previous examiner did not, the examiner should be sure to note that the rationale for all opinions expressed must be provided. 3. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the nature and etiology of the Veteran's chronic fatigue syndrome. The examiner should review the claims file and indicate that review in the report. Any indicated studies should be performed. Based upon the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any current chronic fatigue syndrome is etiologically related to service. In determining the current diagnoses, if it is determined that the Veteran does not have a current diagnosis of a chronic fatigue syndrome, the examiner must reconcile that finding with the diagnoses of record during the pendency of this appeal. The rationale for all opinions expressed must be provided. 4. Confirm that the VA examination report and any opinions provided comport with this remand, and undertake any other development found to be warranted. 5. Then, readjudicate the remaining issues on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Cannaday, 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.