Citation Nr: 21021516 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 12-02 754A DATE: April 13, 2021 REMANDED Issue of entitlement to service connection for gum disease is remanded. Issue of entitlement to service connection for a dental condition is remanded. Issue of entitlement to service connection for a skin disorder is remanded. Issue of entitlement to an increase rating in excess of 10 percent prior to October 13, 2010, for chronic diarrhea is remanded. Issue of entitlement to an initial compensable rating prior to November 1, 2016, for migraine headaches is remanded. Issue of entitlement to an initial rating in excess of 20 percent prior to October 11, 2014, for left shoulder arthralgia is remanded. Issue of entitlement to an increased rating in excess of 20 percent prior to October 11, 2014 for right shoulder arthralgia and in excess of 30 percent thereafter is remanded. Issue of entitlement to an initial rating in excess of 10 percent right foot arthralgia is remanded. Issue of entitlement to an initial rating in excess of 10 percent for left foot arthralgia is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1987 to September 1991. The Veteran is Persian Gulf veteran. This appeal to the Board of Veterans’ Appeals (Board) arose from September 2010 and April 2012 rating decisions issued by the Department of Veterans Affairs (VA). See November 2019 Notice of Disagreement (NOD); January 2012 Statement of the Case (SOC); February 2012 Substantive Appeal (VA Form 9); April 2012 Rating decision; January 2013 NOD; September 2014 SOC; September 2014 VA Form 9. During the pendency of the appeal, the Veteran was granted an increased rating of 30 percent for his right shoulder arthralgia, effective January 31, 2013. March 2015 Rating decision. The Veteran testified before the undersigned Veterans Law Judge in a November 2016 hearing. See November 2016 Hearing transcript. In March 2017, the Board granted the Veteran’s request to reopen his claim of entitlement to service connection for a dental condition. March 2017 Board decision. The Board remanded the underlying claim of service connection for a dental condition and the other claims listed above for further development. Id. The Veteran was granted a higher initial rating of 50 percent for his migraine headaches, effective November 1, 2016. July 2017 Rating decision. He was granted initial ratings for his right shoulder arthralgia of 20 percent, effective November 30, 2009, and 30 percent beginning October 11, 2014. September 2017 Rating decision. In September 2019, the Board remanded his claims of entitlement to service connection for gum disease and a dental condition as intertwined with his claim of entitlement to service connection for metastatic squamous cell carcinoma, which is still on appeal. September 2019 Board decision. The Board denied the Veteran’s other claims. See id. The Veteran appealed the September 2019 Board decision to the Court of Appeals for Veterans Claims (CAVC) and, through a Joint Motion for Partial Remand, the claims were remanded to the Board for further development and reasons and bases. See October 2020 CAVC decision. The Agency of Original Jurisdiction (AOJ) denied the Veteran’s claims of entitlement to service connection for gum disease and a dental condition. January 2021 Supplemental Statement of the Case (SSOC). All of the above claims are now back before the Board. 1. Issue of entitlement to service connection for gum disease is remanded. 2. Issue of entitlement to service connection for a dental condition is remanded. 3. Issue of entitlement to service connection for a skin disorder is remanded. 4. Issue of entitlement to an increase rating in excess of 10 percent prior to October 13, 2010, for chronic diarrhea is remanded. 5. Issue of entitlement to an initial compensable rating prior to November 1, 2016, for migraine headaches is remanded. 6. Issue of entitlement to an initial rating in excess of 20 percent prior to October 11, 2014, for left shoulder arthralgia is remanded. 7. Issue of entitlement to an increased rating in excess of 20 percent prior to October 11, 2014 for right shoulder arthralgia and in excess of 30 percent thereafter is remanded. 8. Issue of entitlement to an initial rating in excess of 10 percent right foot arthralgia is remanded. 9. Issue of entitlement to an initial rating in excess of 10 percent for left foot arthralgia is remanded. Pursuant to the October 2020 CAVC decision, a remand is necessary for further development of the evidence of record. The October 2020 CAVC decision directed that VA attempt to obtain the private treatment records identified by the Veteran, including those from Tri-County Medical Clinic, the Pain Clinic of Michigan, Beaumont Hospital, the University of Michigan Health System, and Basha Diagnostics. The Board recognizes that the claims file already contains treatment records from those facilities, received in September and October 2019. But to fully comply with the CAVC remand directive and provide the Veteran every opportunity to substantiate his claims, the Board finds that an attempt to obtain any outstanding private treatment evidence is needed. The October 2020 CAVC decision also found that the April 2012 VA examination for shoulder and arm conditions is inadequate because it does not test the Veteran’s pain on both active and passive motion, in weight-bearing and nonweight-bearing. While the Veteran was afforded a later VA examination that does consider the Veteran’s active, and passive shoulder motion, and while weight bearing and nonweight-bearing, the VA examiner found the Veteran to have normal ranges of motion in his shoulders, no functional loss with repetitive use over time, and no flare-ups, which is contrary to the prior VA examinations. See April 2012 VA examination for shoulder and arm condition; October 2014 VA examination for shoulder and arm conditions; April 2017 VA examination for shoulder and arm conditions. The Board, thus, finds that the Veteran should be afforded another opportunity for a VA examination for his right and left shoulders. The Board recognizes that the September 2017 rating decision granted a 30 percent rating for the Veteran’s right shoulder arthralgia beginning on October 11, 2014, which, without providing any rationale, is later than the March 2015 rating decision’s grant of a 30 percent rating beginning January 31, 2013. The evaluation for the Veteran right shoulder arthralgia for the entire period on appeal will be addressed on remand after the above development is completed. The Board also notes that the Veteran indicated in an August 2019 correspondence that he submitted a “jump drive enclosed w/ electronic index.” It is unclear if the Veteran’s submitted evidence was added to the claims file. The Board also notes that the Veteran’s representative contended that the Veteran requested a copy of the claims file in February 2012, and VA has not fulfilled that request. See June 2020 Representative’s Summary of Issues. While a review of the claims file did not show a February 2012 request for a copy of the claims file, a copy should be provided to the Veteran and his representative after all of the requested development has been completed. As for the Veteran’s claims of entitlement to service connection for gum disease and a dental condition, the Board finds that there has not been substantial compliance with its September 2019 remand directives. The Veteran asserts that his gum disease and dental condition are secondary to his metastatic squamous cell carcinoma and, thus, the Board directed that a decision his gum disease and dental condition must be deferred until the outcome of that claim has been reached. September 2019 Board decision. The claims file shows that the Veteran perfected his appeal of entitlement to service connection for metastatic squamous cell carcinoma to the Board and the claim is currently still with the Board and pending a request for a hearing. See January 2019 VA Form 9. The Veteran’s claims of entitlement to service connection for gum disease and a dental condition is, again, remanded as intertwined with his claim of entitlement to service connection for metastatic squamous cell carcinoma. The Board also finds that an addendum opinion from a VA examiner is needed for the Veteran’s claim of entitlement to service connection for a skin disorder. The VA examiners have opined that the Veteran has no current skin disorder, but it is unclear if the examiners fully considered the lay statements from the Veteran and his spouse. More recent treatment evidence in 2017 also shows that the Veteran was treatment for dermatofibroma and folliculitis. See June 2017 VA treatment evidence; September 2017 VA treatment evidence. The Board finds that additional development is needed. Finally, the Board notes that an August 2020 opinion from private treatment provider J D, D.O., indicates that the Veteran’s “many health issues” are exacerbated by his lowered immune system, which is now a service connected disability. See July 2020 Rating decision; August 2020 Third party correspondence. The Board finds that an addendum opinion from a VA examiner is needed as to whether the Veteran’s service-connected immune disorder proximately caused, resulted in, or aggravated the Veteran’s claimed gum disease, dental condition, or skin disorder. The matters are REMANDED for the following action: 1. Ask the Veteran to identify the providers of any evaluations and/or treatment received for his claims of gum disease, dental condition, skin disorder, chronic diarrhea, migraine headaches, shoulder arthralgia, and foot arthralgia disabilities, and provide authorizations for VA to obtain records of any such private treatment. (a) Obtain complete clinical records of all pertinent evaluations and treatment (records of which are not already associated with the claims file) from the providers identified. The AOJ should specifically ask about treatment at Tri County Medical Clinic, the Pain Clinic of Michigan, Beaumont Hospital, the University of Michigan Health System, and Basha Diagnostics. (b) The AOJ should verify if the evidence submitted by the Veteran in a “jump drive enclosed w/ electronic index” per the August 2019 Correspondence has been made part of the claims file. If the evidence has not or could not be made part of the claims file, the AOJ should request that the Veteran resubmit that evidence in a format that allows it to be added to the claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right and left shoulder arthralgia, and, if possible, the severity during the entire period on appeal since November 2009. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner should also consider and discuss the range of motion findings in the prior VA examinations. (a) The examiner must test the Veteran’s active motion, passive motion, and pain with weight bearing and without weight-bearing. 3. Obtain an addendum opinion from an appropriate medical professional to determine the nature and cause of the any identified skin disorder. If the medical professional determines that it is necessary, schedule the Veteran for a VA examination. The medical professional should respond to the following: (a) Identify any evidence of a current skin disorder. The examiner should consider and discuss the Veteran’s lay statements during the April 2017 VA examination about having periodic “bumps on his skin” with “pus” and his wife’s statement about “skin lesions.” The examiner must also consider and discuss June 2017 and September 2017 VA treatment records indicating that the Veteran was treated for dermatofibroma and folliculitis; and the October 2010 opinion from treatment provider J D, D.O., that he has treated the Veteran for “dermatological conditions, including eczema” and “nonspecific dermatitis.” (b) For each identified skin disorder, is it at least as likely as not (a 50 percent or greater probability) that it began in (or is otherwise related to) the Veteran’s military service? The examiner should consider and discuss the Veteran’s lay testimony and assertions regarding any pertinent complaints and symptoms. A detailed explanation (rationale) is requested. (c) If the examiner finds the evidence does not support a current skin disorder, presume as true for the purposes of obtaining an opinion only that the Veteran’s eczema and bumps or lesions on his skin with pus as described by Dr. J D and the lay evidence. Is it at least as likely as not (a 50 percent or greater probability) that it began in (or is otherwise related to) the Veteran’s military service? 4. Obtain an addendum opinion from one or more appropriate medical professionals to determine the nature of the Veteran’s service-connected immune disorder and whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran has gum disease, a dental condition, or a skin condition that is proximately due to or the result of his service connected immune disorder. The medical professional should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a current gum disease, dental condition, or skin disorder that is aggravated (any increase in severity) by his service connected immune disorder. The medical professional should consider and discuss the August 2020 opinion from Dr. J D that the Veteran has suffered multiple various conditions due to his compromised immune system. A detailed explanation (rationale) is requested, including citing to supporting clinical data (and/or medical literature), as appropriate. 5. After the development listed above, and any other development deemed warranted by the AOJ, is complete, provide a copy of the claims file to the Veteran and his representative. (Continued on the next page)   6. Readjudicate. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Lin 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.