Citation Nr: 21011529 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 15-11 181 DATE: March 2, 2021 REMANDED Entitlement to service connection for Bartter Syndrome is remanded. Entitlement to service connection for Gitelman Syndrome, to include as secondary to Bartter Syndrome, is remanded. Entitlement to service connection for fibromyalgia, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. Entitlement to service connection for migraines, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. Entitlement to service connection for a neck disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. Entitlement to service connection for a low back disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. Entitlement to service connection for a knee disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. Entitlement to service connection for a shoulder disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. Entitlement to service connection for an ankle disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1976 to January 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. In March 2019, the Board remanded this matter for further development. That development having been completed, this matter has returned to the Board for further appellate review. As a result of the Board’s March 2019 remand, additional relevant service department records were obtained in September 2020. Therefore, the previously denied claim for service connection for Bartter Syndrome must be reconsidered. See 38 C.F.R. § 3.156(c). 1. Entitlement to service connection for Bartter Syndrome is remanded. Congenital and developmental defects are not diseases or injuries within the meaning of the applicable legislation. See 38 C.F.R. §§ 3.303(c), 4.9; see also Winn v. Brown, 8 Vet. App. 510, 516 (1996). For VA purposes, a "defect" is defined as a structural or inherent abnormality or condition that is more or less stationary in nature, and is generally incapable of improvement or deterioration. In contrast, a "disease" is capable of improvement or deterioration. However, service connection may be granted for a congenital or hereditary disease, as opposed to a defect, when the disease first manifested during service (incurrence), or when it preexisted service but was worsened beyond its normal progression as a result of service (aggravation). See Quirin v. Shinseki, 22 Vet. App. 390, 394 (2009) (discussing VAOPGCPREC 82-90); Monroe v. Brown, 4 Vet. App. 513, 514-15 (1993). The Veteran’s claim was initially denied in January 1979 on the grounds that her Bartter Syndrome was hereditary and the record did not demonstrate aggravation. See January 1979 Rating Decision. However, the Board finds that clarification of the nature of the Veteran’s condition is required. Thus, the case is remanded to obtain a medical opinion, as set forth below. 2. Entitlement to service connection for Gitelman Syndrome, to include as secondary to Bartter Syndrome, is remanded. 3. Entitlement to service connection for fibromyalgia, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. 4. Entitlement to service connection for migraines, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. 5. Entitlement to service connection for a neck disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. 6. Entitlement to service connection for a low back disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. 7. Entitlement to service connection for a knee disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. 8. Entitlement to service connection for a shoulder disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. 9. Entitlement to service connection for an ankle disability, to include as secondary to Bartter Syndrome or Gitelman Syndrome, is remanded. Since the remaining claims are inextricably intertwined with the claim of entitlement to service connection for Bartter Syndrome, those are also being remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered); Ephraim v. Brown, 82 F.3d 399 (Fed. Cir. 1996) (claims are inextricably intertwined when they have common parameters, such as when the outcome of one may affect the outcome of the other. And to avoid piecemeal adjudication of these types of claims, they should be considered together). Finally, as this matter is being remanded the Veteran’s updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Make arrangements to obtain the Veteran’s VA treatment records, dated from December 2019, forward. 2. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) for her Bartter Syndrome. The entire claims file, to include a copy of this REMAND, must be reviewed by the examiner in conjunction with the examination. The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the examination. The examiner should elicit a full history from the Veteran. Any medically indicated tests should be conducted. Following a review of the claims file, the examiner is asked to provide opinions on the following: (a) The examiner must explain whether the Veteran's Bartter Syndrome is (i) acquired in nature, (ii) a congenital defect, or (iii) a congenital disease. • For VA adjudication purposes, a congenital "disease" generally refers to a condition considered capable of improving or deteriorating, whereas "defect" generally refers to a condition not considered capable of improving or deteriorating. (b) If the Veteran's Bartter Syndrome is (i) acquired in nature or (ii) a congenital disease, is it at least as likely as not (50% of greater probability) that the condition is related to any incident of service? Did it first manifest in service? (c) If the Veteran's Bartter Syndrome is (i) acquired in nature or (ii) a congenital disease, did it clearly and unmistakably (i.e., undebatably or to the highest degree of medical certainty) first manifest prior to the Veteran's entry into active service? If so, was it clearly and unmistakably NOT aggravated by service? In this context, "aggravation" has occurred where there is an increase in disability beyond the natural progress of the disease. (d) If the Veteran's Bartter Syndrome is a congenital defect (as opposed to a congenital disease), the examiner must opine as to whether it is at least as likely as not (50% of greater probability) that there was a superimposed injury or disease during service that resulted in additional disability, considering her in-service complaints and treatment. If so, describe the resultant disability. (Continued on the next page)   A supporting rationale for all opinions expressed must be provided. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. M. Stedman, 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.