Citation Nr: A21020587 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 210326-146216 DATE: December 28, 2021 REMANDED Entitlement to service connection for shortness of breath is remanded. Entitlement to service connection for gastropathy and duodenopathy is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1990 to September 1994, with service in Southwest Asia from February 1991 to April 1991. In March 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an April 2019 rating decision. In March 2020, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior April 2019 decision. In the March 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 2019 AOJ decision on appeal. 38 C.F.R. § 20.301. In October 2021, the Board remanded the issues of service connection for an eye disability, psychiatric disability, left knee disability, skin disability, erectile dysfunction, and vertigo to the AOJ for further development and adjudication. These issues are currently pending with the AOJ. 1. Entitlement to service connection for shortness of breath is remanded. 2. Entitlement to service connection for gastropathy and duodenopathy is remanded. 3. Entitlement to service connection for a right knee disability is remanded. 4. Entitlement to service connection for headaches is remanded. The Veteran contends that he suffers from shortness of breath, gastropathy and duodenopathy, a right knee disability, and headaches, which are directly related to service, or an unexplained or undiagnosed condition related to his service in Saudi Arabia. Remand is necessary to correct a pre-decisional error in VA's duty to assist the Veteran. In January 2019, the Veteran was provided with a VA Gulf War General Medical Examination. Regarding the Veteran's right knee condition, shortness of breath, stomach issues, and headaches, the examiner found for each of these conditions that it is less likely than not a diagnosed illness with no clear etiology, nor it is a medically unexplained chronic multi-symptom illness of unknown etiology, nor it is an undiagnosed illness. In a March 2019 addendum, the VA examiner stated that the Veteran does not have a disability pattern of shortness of breath. However, the examiner did not address whether any shortness of breath symptoms would result in functional impairment. The VA examiner also stated that the Veteran's gastropathy and duodenopathy are known medical conditions with known etiology. While these medical opinions are probative of whether the Veteran suffers from an undiagnosed or unexplained Gulf War illness, the examination does not address whether the Veteran's current conditions are directly related to exposure to environmental hazards during service in Saudi Arabia. Therefore, remand is necessary to obtain adequate VA examinations to determine the nature and etiology of the Veteran's conditions. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any shortness of breath condition. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including exposure to environmental hazards in Saudi Arabia. (a.) If no respiratory disorder is identified, the examiner must indicate whether any shortness of breath associated with the Veteran's respiratory system causes any functional impairment. The examiner is advised that shortness of breath causing functional impairment will be considered a disability for VA compensation purposes and that there is no requirement of radiographic evidence of pathology. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any gastropathy and duodenopathy. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including exposure to environmental hazards in Saudi Arabia. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right knee disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including service in Saudi Arabia. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any headache condition. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including exposure to environmental hazards in Saudi Arabia. Christopher Seppanen Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Casey, 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.