Citation Nr: 21075957 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 14-05 924 DATE: December 22, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a neck disability is remanded. Entitlement to service connection for a headache disability is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a right wrist disability is remanded. Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for a right elbow disability is remanded. Entitlement to service connection for a left elbow disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for right upper extremity numbness is remanded. Entitlement to service connection for left upper extremity numbness is remanded. Entitlement to service connection for right lower extremity numbness is remanded. Entitlement to service connection for left lower extremity numbness is remanded. Entitlement to service connection for right upper extremity arthritis is remanded. Entitlement to service connection for left upper extremity arthritis is remanded. Entitlement to service connection for right lower extremity arthritis is remanded. Entitlement to service connection for left lower extremity arthritis is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1990 to February 2000. He also had subsequent active duty for training and inactive duty for training in the reserves from February 2000 to January 2010. These matters are before the Board of Veterans' Appeals (Board) on appeal from a September 2010 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In February 2010, the Veteran submitted a Notice of Disagreement with this rating decision. This case was previously before the Board in December 2017, April 2020, and March 2021. At those times, the Board remanded the case for additional development. Unfortunately, for the reasons discussed below, another remand is required. See Stegall v. West, 11. Vet. App. 268 (1998). 1. Entitlement to service connection for a back disability is remanded. 2. Entitlement to service connection for a neck disability is remanded. 3. Entitlement to service connection for a headache disability is remanded. 4. Entitlement to service connection for a right wrist disability is remanded. 5. Entitlement to service connection for a right hip disability is remanded. 6. Entitlement to service connection for a left hip disability is remanded. In the March 2021 remand, the Board ordered the RO to schedule the Veteran for VA examinations to determine if he had diagnoses or experienced functional impairment. If so, the examiner was to give an opinion as to whether the Veteran's diagnoses or functional impairment were related to active service, including periods of active duty for training (ACDUTRA) or inactive duty for training (INACDUTRA), to include his exposure to G-Forces as a pilot. In the May 2021 VA opinion, the examiner noted that the Veteran was diagnosed with retrolisthesis of L4 on L5, cervical degenerative disc disease (DDD), tension headaches, right wrist radiocarpal degenerative joint disease (DJD), and bilateral hip DJD. The VA examiner opined that it was less likely than not that these conditions were incurred in or caused by the in-service injury, event, or illness, to include exposure to G-Forces. The rationale was that medical studies showed no differences in the prevalence of degeneration between fighter pilots and non-flying personnel. Additionally, the examiner noted that there was no evidence of any of these conditions in the Veteran's service-treatment records (STRs). The Board finds this opinion to be conclusory and inadequate. Just because there is not a higher risk of degeneration in pilots does not mean that the Veteran's disabilities are not related to his time as a fighter pilot in active and reserve service. Additionally, the Veteran has stated that he did not report many of his complaints during service because he feared that if he did, he would lose his flight status. Additionally, the Board notes that an in-service diagnosis is not required to establish service connection. Cosman v. Principi, 3 Vet. App. 503 (1992). Because of this, new opinions are necessary to determine if these conditions are related to the Veteran's service, to include as due to exposure to G-Forces as a pilot. 7. Entitlement to service connection for a right shoulder disability is remanded. 8. Entitlement to service connection for a left shoulder disability is remanded. 9. Entitlement to service connection for a left wrist disability is remanded. 10. Entitlement to service connection for a right elbow disability is remanded. 11. Entitlement to service connection for a left elbow disability is remanded. 12. Entitlement to service connection for right upper extremity numbness is remanded. 13. Entitlement to service connection for left upper extremity numbness is remanded. 14. Entitlement to service connection for right lower extremity numbness is remanded. 15. Entitlement to service connection for left lower extremity numbness is remanded. 16. Entitlement to service connection for right upper extremity arthritis is remanded. 17. Entitlement to service connection for left upper extremity arthritis is remanded. 18. Entitlement to service connection for right lower extremity arthritis is remanded. 19. Entitlement to service connection for left lower extremity arthritis is remanded. Noted previously, in the March 2021 remand, the Board ordered the RO to schedule the Veteran for VA examinations to determine if he had diagnoses or experienced functional impairment. If so, the examiner was to give an opinion as to whether the Veteran's diagnoses or functional impairment were related to active service, including periods of ACDUTRA or INACDUTRA, to include his exposure to G-Forces as a pilot. In the May 2021 VA opinion, the VA examiner noted that the Veteran did not have any diagnoses concerning his shoulders, left wrist, bilateral elbows, and bilateral upper and lower extremity numbness and arthritis. However, the VA examiner did not ask the Veteran or determine if the Veteran experienced functional impairment. The Board notes that in a February 2010 Statement In Support of Claim, the Veteran reported that he cannot shake hands due to pain in his wrists and elbows, that his shoulders pop with repetitive movement, and that he had restricted flexibility in his arms. In an August 2010 Statement In Support of Claim, the Veteran noted that his arms, legs, and hips popped with movement, that he had restricted movement in his arms, back, and hips, and that he had hip, upper extremity, and lower extremity pain that made it difficult to do simple tasks. Finally, in his February 2014 VA Form 9, the Veteran wrote that his claimed disabilities caused a lack of mobility. In the March 2021 remand, the Board acknowledged that the Veteran was competent to report symptoms of pain and numbness as these were matters within his personal knowledge, as it came to him through his senses. Layno v. Brown, 6 Vet. App. 465, 470 (1995). The Board further found that the Veteran's reports of pain and numbness were credible as he had consistently reported such symptoms approximate to his periods of service in the Air Force Reserves, and his reports of impairment were credible based on his reported symptoms of pain and numbness. Because the May 2021 VA examinations and opinions failed to address whether the Veteran had disabilities manifested by pain and functional limitation, new opinions regarded the claimed disabilities are required. See Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018); Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following actions: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), contact the Veteran for additional information about treatment for his condition and make efforts to obtain all VA and private treatment records concerning these claims. 2. Arrange for the Veteran's file to be forwarded to a VA examiner for clarifying addendum opinions regarding the likely cause of the Veteran's back, neck, headaches, right wrist, and bilateral hips disabilities. The examiner or consulting physician must review the entire record (including all updated records obtained pursuant to the above development order). Based on his or her review, the examiner or consulting physician should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's conditions are either directly related to active military service OR represent the initial manifestation of his disease, to include as due to G-Forces. The Board notes that in-service diagnoses are not required to establish service-connection. 3. Arrange for the Veteran's file to be forwarded to a VA examiner for clarifying addendum opinions regarding the likely cause of the Veteran's bilateral shoulder, left wrist, bilateral elbow, and upper and lower extremity numbness and arthritis conditions. The examiner or consulting physician must review the entire record (including all updated records obtained pursuant to the above development order). Based on his or her review, the examiner or consulting physician should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran experienced functional impairment that was either directly related to active military service OR represent the initial manifestation of his diseases, to include as due to G-Force exposure. In reaching any conclusion, the VA examiner should consider: (a.) The February 2010 statement where the Veteran reported that he could not shake hands due to pain in his wrist and elbows, that his shoulders popped with repetitive movement, and that he had restricted flexibility in his arms, (b.) The August 2010 statement where the Veteran noted that his arms, legs, and hips popped with movement, that he had restricted movement in his arms, back, and hips, and he had hip and bilateral upper and lower extremity pain that made it difficult to do simple tasks, (c.) The February 2014 VA Form 9 where the Veteran wrote that his disabilities caused a lack of mobility; 4. If, and only if, the VA examiner finds that at least one of Veteran's conditions or functional impairment is related to service, the examiner is ordered to provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's conditions or functional impairment were caused OR aggravated by the disability that is related to service. (Continued on next page) 5. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Abrams, 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.