Citation Nr: 21071569 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-58 031 DATE: November 30, 2021 REMANDED Service connection for a chronic pain disorder, initially claimed as complex pain syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 2002 to September 2007, to include service in the Persian Gulf. The matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision. The Veteran seeks service connection for a chronic pain disorder. In July 2007, the Veteran was medically discharged from service due to right ulnar nerve neuritis, traumatic arthritis of the right elbow, and chronic medial and lateral epicondylitis. He was also diagnosed with chronic pain syndrome during service. Since service he has consistently complained of neck, back, right shoulder, and right arm pain. Various VA providers have related his pain to muscle spasms, neuropathies, mechanical factors, complex regional pain syndrome (CRPS), and, most recently, myofascial pain. The records do not show, however, that a definitive diagnosis or etiology has been established. For example, while the Veteran was assessed with atypical CRPS in July 2016, VA rheumatologists and pain clinic providers subsequently stated he does not have CRPS in December 2015 and May 2019. Currently, the Veteran is service-connected for right ulnar nerve paralysis, a right shoulder condition, lumbar strain with degenerative arthritis, cervical spine spondylosis and degenerative disc disease, right ankle strain, right elbow arthritis, and right hand strain. He underwent a VA peripheral nerves examination in July 2017, at which time the VA examiner diagnosed him with right ulnar neuropathy and left lateral femoral cut [sic] neuropathy. The examiner opined that the Veteran's neuropathies are not related to Gulf War service as they have known compressive causes. The Veteran was not afforded another VA examination. It is unclear from the records whether the Veteran's symptoms stem from his already-service connected disabilities versus a distinct chronic pain disorder, and, if the latter, whether any chronic pain disorder is related to his Gulf War service or is secondary to his service-connected disabilities. Accordingly, the Board finds that a remand is necessary for a medical opinion to assist in assessing the Veteran's claim. Because the Board finds that a specialist is necessary to answer these questions, the Board will remand for a medical opinion only to ensure the availability is not limited by physical location. If an examination is determined necessary, the AOJ should obtain an examination and medical opinions from the examining provider and appropriate specialist, if the examining provider is not a specialist due to lack of availability. The matters are REMANDED for the following action: 1. Obtain the Veteran's treatment records from West LA VAMC from April 2020 to the present. 2. Forward the claims file to a VA examiner (or examiners) who specializes in chronic pain disorders, to include myofascial pain syndrome. Considering the medical complexity of this issue, a nurse practitioner or physician's assistant is not best-suited to answer these questions, but, rather a medical doctor who specializes in chronic pain disorders. If the examiner determines an in-person examination is necessary, the AOJ should complete instruction #3. After reviewing the claims file, the examiner should respond to the following: (a.) Does the Veteran have a chronic pain disorder, such as myofascial pain syndrome or complex regional pain syndrome, that is separate from his current service-connected disabilities? (b.) DIRECT SERVICE CONNECTION: If so, is it at least as likely as not that the chronic pain disorder began in service? (c.) SECONDARY SERVICE CONNECTION: If not, is it at least as likely as not that the chronic pain disorder is caused by or aggravated by his current service-connected disabilities? (d.) SERVICE CONNECTION BASED ON GULF WAR SYNDROME: If not, is it at least as likely as not that his symptoms are manifestations of an undiagnosed illness or medically unexplained chronic multisymptom illness? (e.) The examiner should consider the following evidence in forming an opinion: i. In-service treatment for chronic pain syndrome from March 2007 to June 2007; ii. April 2007 Medical Board findings and May 2007 and July 2007 Physical Evaluation Board proceedings; iii. July 2017 VA peripheral nerves examination and August 2017 addendum opinion; iv. VA rheumatology records dated April 2015, September 2015, and December 2015; and v. VA pain clinic records, to include those dated July 2016, February 2018, and May 2019. 3. If it is determined that a physical examination is necessary, schedule the Veteran for an examination with an appropriate provider (see discussion above) and ensure the Board's questions are answered by that provider and an appropriate specialist(s), if the examination cannot be conducted by the specialist due to availability/location. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lavan 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.