Citation Nr: 21011053 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-15 686 DATE: February 26, 2021 REMANDED Entitlement to service connection for rheumatoid arthritis is remanded. Entitlement to service connection for headaches, to include as secondary to rheumatoid arthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2000 to September 2004 with a period of active duty for training (ACDUTRA) from September 2011 to December 2011 and additional service in the Reserves. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision issued by the Department of Veterans’ Affairs (VA) Regional Office (RO) in Portland, Oregon. By way of background, the RO denied service connection in the July 2014 rating decision from which the Veteran timely appealed requesting a Decision Review Officer (DRO) review the claim. A March 2016 Statement of the Case (SOC) was issued continuing the denial of service connection for both claims. The Veteran elected a hearing before the Board which occurred in November 2020, a transcript of which has been associated with the claims file and reviewed. 1. Entitlement to service connection for rheumatoid arthritis is remanded. The Veteran contends his rheumatoid arthritis began during active duty service or during his period of ACDUTRA. The Board finds the evidence of record is insufficient to resolve the Veteran’s claim. Remand is required to obtain clarification regarding the onset of the Veteran’s rheumatoid arthritis. Where a private examination report reasonably appears to contain information that is "relevant, factual, and objective" and is necessary to properly decide a claim, VA has a duty to either (1) ask the private examiner to clarify the report, or (2) request that the claimant obtain the necessary information to clarify the report. Savage v. Shinseki, 24 Vet. App. 259, 269 (2011). VA has very little ability to compel non-VA medical personnel to comply with such a request, but can request information in "those instances in which the missing information is relevant, factual, and objective that is, not a matter of opinion and where the missing evidence bears greatly on the probative value of the private examination report." Savage, 24 Vet. App. at 269. The Veteran submitted an opinion from a private provider who opined that the Veteran’s rheumatoid arthritis was “incurred during your military service in the preceding year(s).” See February 2019 and January 2020 non-government treatment records. Of note, the Veteran has a period of active duty service from September 2000 to September 2004 and ADUTRA from September 2011 to December 2011. The Veteran contends his symptoms during both periods were manifestations of his rheumatoid arthritis. The specific onset of the Veteran’s disability is relevant to the resolution of his service connection claim and is unclear from the February 2019 private provider’s opinion. The missing evidence of onset according to the private provider bears greatly on the probative value of the opinion. Additionally, the same provider completed a line of duty determination indicating that the Veteran’s injury referenced to be rheumatoid arthritis was incurred in the line of duty, however, the accident information date listed references a date on which the Veteran was neither active duty nor ACDUTRA. See May 2012 Statement of Medical Examination and Duty Status. Thus, remand is necessary to attempt to obtain clarification of the private provider’s report. Remand is also required to obtain a direct service connection nexus opinion as the VA examinations of record are not adequate regarding direct causation for the Veteran’s ACDUTRA service. The Veteran was afforded a VA examination in April 2014 wherein the examiner provided a negative nexus opinion based on the reasoning that the Veteran’s STRs lacked an evaluation, treatment, or diagnosis of rheumatoid arthritis. An addendum opinion was obtained in March 2016 wherein the VA examiner mentioned the Veteran reported ankle tendinitis during ACDUTRA but did not provide an opinion as to whether it was a manifestation of rheumatoid arthritis which was diagnosed months later because an opinion had not been requested. The Board finds an opinion regarding this contended injury during ACDUTRA and its relation, if any, to the Veteran’s rheumatoid arthritis is necessary for the Board to make a fully informed decision regarding the Veteran’s claim. See Ardison v. Brown, 6 Vet. App. 405, 407 (1994) Consequently, the Board finds remand is necessary to obtain an addendum VA opinion addressing whether the Veteran’s reported ankle tendinitis during ACDUTRA was a manifestation of his later diagnosed rheumatoid arthritis. 2. Entitlement to service connection for headaches, to include as secondary to rheumatoid arthritis, is remanded. The Veteran contends his headaches are caused or aggravated by his rheumatoid arthritis or the medications taken for treatment thereof. The Board finds remand is required regarding this claim as it is inextricably intertwined with the pending service connection claim for rheumatoid arthritis. Within this decision, the Board has remanded service connection for rheumatoid arthritis for additional development. A decision regarding the Veteran’s secondary service connection claim for headaches cannot be made until his underlying service connection claim is decided. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Thus, this claim is remanded as inextricably intertwined with the Veteran’s service connection claim for rheumatoid arthritis. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he complete and return a signed authorization to allow VA to obtain clarifying information from the February 2019/January 2020 private provider. If the Veteran submits any authorization that is insufficient for further action, he should be notified, and any such notification should be properly documented in the claims file. 2. Upon receipt of a valid authorization, the RO shall contact the February 2019/January 2020 private provider and request clarification regarding the specific onset of the Veteran’s rheumatoid arthritis. All attempts to seek clarification, and any responses received, must be documented in the claims file. 3. Return the entire claims file and this remand to an appropriate VA examiner for review. The necessity of an in-person examination is left to the discretion of the examiner. The examiner shall provide an opinion, including rationale, as to whether it is at least as likely as not (50 percent or greater probability) the Veteran’s rheumatoid arthritis had its onset during his ACDUTRA service from September 2011 to December 2011 including the Veteran’s reported ankle tendinitis. The examiner is directed to consider the Veteran’s reports of an ankle injury during ACDUTRA despite a lack of service treatment records from ACDUTRA. The examiner must provide a complete rationale for any opinion expressed, based on the examiner’s clinical and medical expertise; established medical principles; and references to the evidence of record, as appropriate. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. After the above development, and any additionally indicated development, has been completed, readjudicate all of the issues on appeal including those remanded as inextricably intertwined. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.C. Allen, Associate 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.