Citation Nr: 21016126 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 14-28 397A DATE: March 19, 2021 REMANDED Service connection for a bilateral foot disorder, including gout and bone spurs of the feet, to include as due to contaminated water exposure at Camp Lejeune. Service connection for muscle spasm of the right leg, to include as due to contaminated water exposure at Camp Lejeune. Service connection for muscle spasm in the left leg, to include as due to contaminated water exposure at Camp Lejeune. Service connection a disorder manifested by joint and muscle pain, including fibromyalgia and rheumatoid arthritis, to include as due to contaminated water exposure at Camp Lejeune.   REASONS FOR REMAND The Veteran served on active duty from September 1973 to September 1975. The case is on appeal from February and October 2012 rating decisions. In July 2015, the Veteran testified at a Board hearing. In October 2016 and August 2020, the Board remanded the appeal for additional development. 1. Service connection for a bilateral foot disorder, including gout and bone spurs of the feet, to include as due to contaminated water exposure at Camp Lejeune. 2. Service connection for muscle spasm of the right leg, to include as due to contaminated water exposure at Camp Lejeune. 3. Service connection for muscle spasm in the left leg, to include as due to contaminated water exposure at Camp Lejeune. 4. Service connection a disorder manifested by joint and muscle pain, including fibromyalgia and rheumatoid arthritis, to include as due to contaminated water exposure at Camp Lejeune. Pursuant to the Board’s August 2020 remand, a VA addendum opinion was obtained in September 2020. The opinion states that the disorders claimed on appeal were not aggravated by service-connected major depressive disorder (MDD) or bilateral hearing loss. However, sufficient rationales were not provided for the opinion. Specifically, the opinion does not address the possible relationship between fibromyalgia and service-connected MDD, as well as a link between fibromyalgia and muscle spasms/strain of the legs indicated in the March 2019 VA opinion; or the June 2020 rating decision reflecting a Favorable Finding that service-connected bilateral hearing loss affected the Veteran’s ability to ambulate, together with the Veteran’s use of a cane due to arthritis, fibromyalgia, gout and/or polymyalgia, reflected in November 2018 VA treatment records. In addition, and although the opinion cited medical literature noting secondary causes of muscle spasms in the legs included medication, the opinion does not address such with respect to the Veteran’s service-connected MDD and associated psychotropic medications. See August 2020 VA treatment records. As such, the September 2020 VA addendum opinion is not completely adequate, and thus, remand for a new addendum opinion is required. In view of the remand, VA treatment records since the issuance of the October 2020 supplemental statement of the case (SSOC) should be obtained. The matters are REMANDED for the following action: 1. Obtain VA treatment records since October 2020. 2. After obtaining any outstanding records, provide the claims file to an appropriate clinician, other than the clinician who provided the September 2020 VA addendum opinion. The need for another examination (or telehealth interview, records request, etc. if an in-person examination is not feasible) for a disorder manifested by muscle and joint pain, to include fibromyalgia and rheumatoid arthritis; muscle spasms of the right and left leg; and a bilateral foot disorder, including gout and bone spurs, is left to the discretion of the medical professional offering the opinion. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any disorder manifested by muscle and joint pain, to include fibromyalgia and rheumatoid arthritis; muscle spasms of the right and left leg; or a bilateral foot disorder, including gout and bone spurs, or any other diagnosed foot disorder: (a.) Had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease, including as a result of presumed exposure to contaminated water at Camp Lejeune; (b.) Was caused by service-connected bilateral hearing loss or MDD and associated medications, or any disorder determined to be related to service; or (c.) Was aggravated by service-connected bilateral hearing loss or MDD and associated medications, or any disorder determined to be related to service. Aggravation is an increase in severity beyond the natural progress of the disease. For any aggravation found, the clinician should state, to the extent possible, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. In rendering the opinions, the evidence should be considered, to include the March 2019 VA examination report and medical literature cited therein, including with respect to a possible relationship between fibromyalgia and service-connected MDD and associated psychotropic medications, as well as a link between fibromyalgia and muscle spasms/strain of the legs, and the June 2020 rating decision reflecting a Favorable Finding that service-connected bilateral hearing loss affected the Veteran’s ability to ambulate, together with the Veteran’s use of a cane due to arthritis, fibromyalgia, gout and/or polymyalgia, noted in November 2018 VA treatment records. Rationale for all opinions expressed should be provided. If the clinician cannot provide some or all of such opinions, the clinician must make clear that he or she has considered all relevant, procurable data, but that any member of the medical community at large could not provide such an opinion without resorting to speculation. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Taylor 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.