Citation Nr: 21020697 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 12-15 815 DATE: April 8, 2021 ORDER Entitlement to service connection for complex regional pain syndrome (CRPS) of the right hip, claimed as a right hip disability, is granted. Entitlement to service connection for CRPS of the left hip, claimed as a left hip disability, is granted. Entitlement to service connection for CRPS of the low back, claimed as a back disability, is granted. REMANDED In addition, the issue of entitlement to service connection for a left ankle disability is remanded to the agency of original jurisdiction (AOJ) for additional action. FINDINGS OF FACT 1. The evidence is in equipoise as to whether the Veteran has a diagnosis of CRPS affecting her hips and back. 2. The evidence is in equipoise as to whether the Veteran’s bilateral hips and back disabilities are etiologically related to her service-connected right knee disability. CONCLUSIONS OF LAW 1. The criteria for service connection for complex regional pain syndrome (CRPS) of the right hip are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 2. The criteria for service connection for CRPS of the left hip are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 3. The criteria for service connection for CRPS of the low back are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1986 to October 1987. This matter comes to the Board of Veterans Appeals (Board) on appeal from June 2012 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The issues were most recently remanded in January 2019, in addition to the issue of entitlement to a total disability rating based on individual unemployability (TDIU) prior April 11, 2014. Through a March 2019 rating decision, the AOJ granted a TDIU effective April 23, 2013. As noted above, the claims being granted herein have been on appeal since at least June 2012 and may impact a decision on an earlier entitlement to a TDIU. Thus, the issues are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). However, in March 2020, the Veteran elected to have the TDIU claim reviewed under the Appeals Modernization Act (AMA) by filing a VA Form 10182, and elected the Evidence Submission docket. Therefore, the claim has been removed from the legacy review system and will be addressed in a later Board decision. The Veteran also has several other claims pending in the AMA review system under the Evidence Submission docket that will be addressed in future Board decisions. Service Connection 1. Service connection for a right hip disability; 2. Service connection for a left hip disability; and, 3. Service connection for a low back disability The Veteran contends that she has a diagnosis of CRPS affecting her hips and back that is etiologically related to her service-connected right knee disability. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Analysis The first question goes to the Veteran’s current diagnoses. The Veteran contends that she has a diagnosis of CRPS. The Board remanded the Veteran’s claims to determine what, if any, diagnoses the Veteran has and whether they are etiologically related to service. The Board finds the September 2019 VA examinations and opinions and the private opinions of A.A., M.D., to be the most probative because they had the most medical evidence at their disposal to review and have the medical training to diagnose the Veteran’s conditions. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The September 2019 VA examinations all contain the same rationale related to whether the Veteran has a diagnosis of CRPS: “Veteran does not have a diagnosis of [CRPS] because of lack of objective factors (findings, signs, or symptoms) to support a current diagnosis of CRPS. Review of medical records does not indicate a diagnosis of CRPS. She was diagnosed with CRPS in December 2016 by A.A., M.D who wrote a nexus letter and diagnosed veteran with CRPS; however review of medical records including orthopedic and rheumatology consultations do not indicate a diagnosis of CRPS.” The Board interprets this opinion to mean that the Veteran does not have a diagnosis of CRPS because the Veteran’s medical records, other than from Dr. A.A., do not contain a diagnosis of CRPS. In contrast, the December 2016 and December 2020 private opinions of Dr. A.A. review the medical record to determine why the records themselves support a diagnosis of CRPS, rather than the absence of a formal diagnosis. Further, the December 2020 opinion addressed the findings and opinions of the September 2019 VA examiner. Given this, the Board finds that the opinions of are relatively equal probative value, such that the evidence is in equipoise on the issue of the current disability. Resolving doubt in favor of the Veteran, the Board finds the Veteran has a diagnosis of CRPS of her bilateral hips and low back and the first criteria for service connection, a current disability, has been met. Shedden, supra. Turning to whether the Veteran’s CRPS was caused or aggravated by the Veteran’s service-connected right knee condition, the opinions of Dr. A.A. answered those questions in the affirmative by explaining that an injury to one area can progress to multiple areas and become disabling, as evidenced by the Veteran’s pain and inability to walk, and CRPS can elude detection on radiographs. The Board gives this opinion great probative weight because the private opinion reviewed the medical record, provided support for her conclusions, and cited medical research in support of her position. Nieves-Rodriguez, supra. In contrast, the VA opinions answered the question in the negative because of the finding that the Veteran did not have diagnoses of CRPS [in VA medical records]. Given the above, the Board finds the criteria for service connection for CRPS of the bilateral hips and low back to be met. Thus, service connection for these conditions is granted. Absent a relative balance of the evidence for and against the claim, the evidence is not in equipoise and the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND 4. Entitlement to service connection for a left ankle disability is remanded. The Veteran contends that she should be service-connected for a left ankle disability. The AOJ issued a statement of the case in December 2019 and the Veteran timely appealed to the Board (form 9). Thereafter, additional VA medical records were associated with the record that address the Veteran’s left ankle condition. However, no Supplemental Statement of the Case was created and/or provided to the Veteran. The Veteran did not waive AOJ review of the evidence. Therefore, the issue must be remanded so that the AOJ may consider the additional evidence and issue a supplemental statement of the case as to the issue of entitlement to service connection for a left ankle condition in consideration of the additional evidence. See 38 C.F.R. §§ 19.31, 20.1304(c). Thereafter, the claim should be certified to the Board for review. The matters are REMANDED for the following action: Readjudicate the issue of service connection for a left ankle condition, in light of the relevant records added to the file since the December 2019 statement of the case. Bethany L. Buck Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board I. M. Hitchcock 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.