Citation Nr: 21022222 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 18-22 095 DATE: April 15, 2021 REMANDED 1. Entitlement to service connection for a bilateral shoulder disorder, to include as due to an undiagnosed illness, is remanded. 2. Entitlement to service connection for a low back disorder, to include as due to an undiagnosed illness, is remanded. 3. Entitlement to service connection for a left knee disorder, to include as due to an undiagnosed illness, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from July 2009 to August 2014, to include service in Afghanistan. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a March 2015 Department of Veterans Affairs (VA) rating decision. In April 2021, a hearing was held before the undersigned. The hearing transcript will still be processed and associated with the claims file in the ordinary course of business. The Veteran’s service treatment records (STRs) show that he was seen for bilateral shoulder pain, low back pain, and knee pain during his active service. He was also involved in a motor vehicle accident during his active service. The Veteran’s postservice medical records show that he continued to report shoulder, low back, and knee pain after his separation from active service. On March 2013 VA examination, the examiner found that the Veteran did not have a shoulder, low back, or left knee diagnosis. On March 2018 VA examination, lumbar spine strain and bilateral knee strain were diagnosed. The examiner opined that the Veteran’s low back disorder was less likely than not due to his active service as his symptoms were subjective only with no evidence of a chronic condition. The examiner did provide an opinion regarding the etiology of any left knee disorder. Neither VA examiner provided an explanation accounting for the Veteran’s current symptoms of bilateral shoulder, low back, and left knee pain. In Saunders v. Wilkie, No. 17-1466 (Fed. Cir. 2018), the Federal Circuit held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. To establish the presence of a disability, the Veteran will need to show that his pain reaches a level of functional impairment of earning capacity. Subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by the Veteran’s pain symptoms. In addition, as the Veteran is a Gulf War Veteran, the examiner should determine if the Veteran’s complaints of joint pain constitute an undiagnosed illness or a medically unexplained chronic multisystem illness. Accordingly, another examination of the Veteran is necessary. The matters are REMANDED for the following: 1. With the Veteran’s assistance (identifying providers and submitting authorizations for VA to obtain any private treatment records), obtain for the record any outstanding medical records pertaining to evaluations and treatment he received for his bilateral shoulder disorder, low back disorder, and left knee disorder that are not already associated with the claims file. 2. Then, arrange for the Veteran to examined by an appropriate clinician (in orthopedics) to determine whether he has right or left shoulder, low back, and left knee disabilities, including as disabilities manifested by pain that causes functional impairment so as to warrant a finding of a compensable disability of the joint in question. The examiner should provide responses to the following: a. Identify each diagnosed shoulder, back, and/or left knee disability found/shown by the record during the pendency of the instant claims. b. Identify the likely etiology for each such disability entity diagnosed. Specifically, is it at least as likely as not (a 50 percent or better probability) that the diagnosed disability is etiologically related to the Veteran’s active duty service, to include as related to complaints noted and activities therein? c. If underlying pathology for pain in either shoulder, the left or the back is not found (there is no clinical diagnosis), opine further whether the pain manifested in that joint reported is shown to result in any impairment so as to constitute a disability on that basis. All opinions must include rationale that cites to supporting clinical findings and medical principles (and acknowledges the Federal Circuit Court holding that pain of itself, without underlying pathology, may constitute a disability if it results in functional impairments that impairs earning capacity). GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Berryman, 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.