Citation Nr: 21074590 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 17-43 988 DATE: December 15, 2021 REMANDED Entitlement to service connection for hypothyroidism, to include as due to undiagnosed illness, is remanded. Entitlement to service connection for a right elbow disability, to include as due to undiagnosed illness, is remanded. Entitlement to service connection for a left elbow disability, to include as due to undiagnosed illness, is remanded. Entitlement to service connection for a right knee disability, to include as due to undiagnosed illness, is remanded. Entitlement to service connection for a left knee disability, to include as due to undiagnosed illness, is remanded. Entitlement to service connection for a left ankle disability, to include as due to undiagnosed illness, is remanded. REASONS FOR REMAND The Veteran served in the United States Coast Guard Reserve from March 1987 to May 1987, and she served on active duty in the United States Air Force from March 2003 to March 2004, to include service in Iraq. She also had service in the United States Air Force Reserve. Her decorations include the Air Force Achievement Medal and the Air Force Outstanding Unit Award with Valor and two devices. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Reno, Nevada. The issues on appeal were previously before the Board in June 2020, when they were remanded to the agency of original jurisdiction (AOJ) for additional development. After taking further action, the AOJ confirmed and continued the prior denials and returned the case to the Board. The issues on appeal previously included entitlement to service connection for asthma and a skin disability. In January 2020, while the case was in remand status, the AOJ granted those claims. As such, those issues are no longer on appeal. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Although the Board regrets the additional delay, the Veteran's claims must again be remanded for additional development. 1. Entitlement to service connection for hypothyroidism, to include as due to undiagnosed illness, is remanded. 2. Entitlement to service connection for a right elbow disability, to include as due to undiagnosed illness, is remanded. 3. Entitlement to service connection for a left elbow disability, to include as due to undiagnosed illness, is remanded. 4. Entitlement to service connection for a right knee disability, to include as due to undiagnosed illness, is remanded. 5. Entitlement to service connection for a left knee disability, to include as due to undiagnosed illness, is remanded. 6. Entitlement to service connection for a left ankle disability, to include as due to undiagnosed illness, is remanded. Additional development is required to attempt to obtain potentially existing and outstanding treatment records. The Veteran reported receiving treatment from Tahoe Fracture and Orthopedic, and she submitted treatment records from that facility dated in July 2013 and March 2014. However, it does not appear the complete records from that facility have been obtained. In this regard, the records submitted by the Veteran reference treatment from the private provider dating back to September 2010. Additionally, an August 2017 VA treatment record references magnetic resonance imaging (MRI) from Tahoe Fracture and Orthopedic. Because additional records from this provider, if obtained, could bear on the outcome of the Veteran's appeal, specific efforts should have been made to procure them. See, e.g., 38 C.F.R. § 3.159(e)(2) (if VA becomes aware of the existence of relevant records before deciding a claim, VA will, among other things, request that the claimant provide a release for the records). Additionally, the Board finds that the VA examination reports obtained on remand are incomplete. The November 2020 VA examiner did not adequately discuss whether the Veteran's disabilities met the definition of a medically unexplained chronic multi-symptom illness (MUCMI) under 38 C.F.R. § 3.317. Specifically, the examiner failed to address whether the disabilities at issue have an etiology and pathophysiology that is conclusive or partially understood. Medical opinions addressing that question are needed. These matters are REMANDED for the following action: 1. Ask the Veteran to provide a release for relevant records of treatment from Tahoe Fracture and Orthopedic, and to identify, and provide appropriate releases for, any other care providers who may possess new or additional evidence pertinent to the issues on appeal. If she provides the necessary release(s), assist her in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact, and the Veteran and her representative should be notified. 2. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 3. After the foregoing development has been completed to the extent possible, make arrangements to obtain an addendum opinion from an appropriate clinician regarding the etiology of the disabilities of the Veteran's elbows, knees, and left ankle. After reviewing the record, the examiner should offer an opinion as to whether the signs and symptoms of the disabilities at issue are most consistent with (1) an undiagnosed illness; (2) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology and pathophysiology; (3) a diagnosable chronic multi-symptom illness with a partially explained etiology and pathophysiology; or (4) a disease with a clear and specific diagnosis, etiology, and pathophysiology. In so doing, the examiner should offer an opinion, with respect to each diagnosed disability, as to whether the etiology OR pathophysiology of the condition is not understood AT ALL in this particular Veteran. A complete medical rationale for all opinions expressed must be provided. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner(s) selected to offer the requested opinions. 4. Also arrange to obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's hypothyroidism. After reviewing the record, the examiner should offer an opinion as to whether the signs and symptoms of the Veteran's thyroid disability are most consistent with (1) an undiagnosed illness; (2) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology and pathophysiology; (3) a diagnosable chronic multi-symptom illness with a partially explained etiology and pathophysiology; or (4) a disease with a clear and specific diagnosis, etiology, and pathophysiology. In so doing, the examiner should offer an opinion, with respect to any diagnosed disability, as to whether the etiology OR pathophysiology of the condition is not understood AT ALL in this particular Veteran. A complete medical rationale for all opinions expressed must be provided. The need for another examination and/or telephonic or video interview of the Veteran is left to the discretion of the examiner(s) selected to offer the requested opinions. 5. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and her representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Kettler, 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.