Citation Nr: 21022330 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 17-28 080 DATE: April 15, 2021 REMANDED Entitlement to service connection for chronic fatigue syndrome, including as due to an undiagnosed disability, is remanded. Entitlement to service connection for chronic constipation (claimed as a gastrointestinal disability), including as due to an undiagnosed disability, is remanded. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for a bilateral hip disability, including as due to an undiagnosed disability, is remanded. Entitlement to service connection for a bilateral hand disability, including as due to an undiagnosed disability, is remanded. Entitlement to service connection for a bilateral foot disability, including as due to an undiagnosed disability, is remanded. Entitlement to service connection for a right elbow disability, including as due to an undiagnosed disability, is remanded. Entitlement to service connection for a left elbow disability, including as due to an undiagnosed disability, is remanded. Entitlement to service connection for a bilateral knee disability, including as due to an undiagnosed disability, is remanded. Entitlement to a rating in excess of 20 percent for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran had active service from September 1977 to September 1999. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2010, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the Veteran’s electronic claims folder. 1. Entitlement to service connection for chronic fatigue syndrome, including as due to an undiagnosed disability, is remanded. The Veteran contends that he is entitled to service connection for chronic fatigue syndrome because he has felt of feeling of fatigue since his 9th or 10th year in service until the present. See Board Hearing Transcript, pp. 5-6. He testified that he saw a doctor about his fatigue within 1- or 2-years post service. Id. The Veteran was afforded a Gulf War examination and chronic fatigue syndrome examination in October 2014 where the examiner noted a diagnosis of chronic fatigue syndrome. However, no medical opinion was provided. Therefore, the Board finds that a remand is necessary to obtain a medical opinion which addresses the etiology of the Veteran’s claimed chronic fatigue syndrome. 2. Entitlement to service connection for chronic constipation (claimed as a gastrointestinal disability), including as due to an undiagnosed disability, is remanded. The Veteran contends that he is entitled to service connection because he ate bad food in the service and was also on narcotic medication which caused constipation. See Board Hearing Transcript, p. 7. In October 2014, the Veteran was afforded a Gulf War disability examination. However, no medical opinion was provided about the etiology of the Veteran’s claimed constipation. Therefore, the Board finds that a remand is necessary to obtain requisite medical opinions. 3. Entitlement to service connection for an acquired psychiatric disability, to include PTSD is remanded. The Veteran contends that he is entitled to service connection for PTSD because he “killed another human being,” and he is always thinking about it. The Veteran was afforded a VA PTSD examination in September 2014 where the examiner opined that the Veteran did not have PTSD or any other mental disorder. On his January 2015 Notice of Disagreement (NOD), he stated that the examination was not thorough enough and only lasted for 10 minutes. The Veteran also testified that he was diagnosed with PTSD and received psychiatric treatment at the VA. See Board Hearing Transcript, p. 12. VA treatment records indicate that the Veteran had a positive PTSD screening. At a March 2014 Gulf War registry examination, the Veteran endorsed symptoms of depression, anxiety, nightmares and flashback. As there is a question as to the adequacy of the September 2014 VA examination, the Board finds that a remand is necessary to obtain a new examination. Also, on remand, up to date VA treatment records should be obtained as the Veteran testified that he receives regular treatment at VA. 4. Entitlement to service connection for a bilateral hip disability, hand, foot, elbow and knee disability, including as due to an undiagnosed disability, is remanded. The Veteran contends that he is entitled to service connection for a bilateral hip, hand, foot, elbow, and knee disability because he experienced joint pain but no official diagnosis. See January 2015 Notice of Disagreement (NOD). At a March 2014 Gulf Registry exam, he reported musculoskeletal problems since 2000. In October 2014, the Veteran was afforded a Gulf War disability examination. However, no medical opinion was provided about the etiology of the Veteran’s various joint pains. Therefore, the Board finds that a remand is necessary to obtain requisite medical opinions. 5. Entitlement to a rating in excess of 20 percent for a left shoulder disability is remanded. The Veteran contends that he is entitled to a rating in excess of 20 percent for a left shoulder disability because he “can’t even lift a piece of paper with [his] left hand.” The Veteran was last afforded a VA shoulder and arm conditions examination in October 2014 where the examiner noted flexion to 160 degrees. The Veteran’s Board testimony indicates that there may have been worsening since the last examination. Therefore, the Board finds that a remand is necessary to afford the Veteran an examination which assesses the current severity of his left shoulder disability. The matters are REMANDED for the following action: 1. Obtain up to date VA treatment records (including psychiatric treatment records). See Board Hearing Transcript, p. 12. 2. Schedule the Veteran for an appropriate VA examination by a VA psychiatrist or psychologist to determine the nature and etiology of any diagnosed acquired psychiatric disabilities. The claims folder should be made available to the examiner for review in connection with the examination and the examiner should acknowledge such review in the examination report. Following interview of the Veteran and review of the claims folder, the examiner is requested to provide opinion on the following: (a) If the examiner finds that the Veteran meets the criteria for a PTSD diagnosis in accordance with the DMS-5, he/she should specifically identify which stressors are linked to the PTSD diagnosis. The Veteran was engaged in combat and therefore is entitled to the combat presumption. 38 U.S.C. § 1154 (b); 38 C.F.R. § 3.304 (d). The examiner’s attention is directed to the following: (i) VA treatment records which indicate that the Veteran had a positive screen for PTSD and (ii) the Veteran’s testimony at the Board hearing that he had been diagnosed with PTSD. (b) If the examiner finds that the Veteran does not meet the criteria for a PTSD diagnosis, opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran has an acquired psychiatric disorder in accordance with the DSM-5 diagnostic criteria that is related to events in service as described by the Veteran. A complete rationale, with citation to appropriate medical principles, is requested. 3. Obtain a medical opinion from the October 210 VA examiner (or suitable substitute) regarding the etiology of the Veteran’s claimed chronic fatigue syndrome and constipation disabilities. The Veteran’s electronic claims folder, including a copy of this remand, must be provided to the examiner. The examiner is requested to provide any opinion as to the following: (i) The examiner should provide a diagnosis of any disorder manifested or, in the case that no diagnosis can be made, opine whether it is at least as likely as not (50 percent probability or greater) the Veteran’s symptom or symptoms are related to an undiagnosed illness or related to a medically unexplained chronic multi symptom illness. (ii) If the Veteran’s symptoms of chronic fatigue are related to a diagnosed disability, whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder began in or is related to the Veteran’s active duty service. (iii) If the Veteran’s symptoms of constipation are related to a diagnosed disability, whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder began in or is related to the Veteran’s active duty service. A complete rationale, with citation to appropriate medical principles, is requested. 4. Obtain a medical opinion from the October 210 VA examiner (or suitable substitute) regarding the etiology of the Veteran’s bilateral hip disability, hand, foot, elbow and knee disabilities. The Veteran’s electronic claims folder, including a copy of this remand, must be provided to the examiner. The examiner is requested to provide any opinion as to the following: (i) The examiner should provide a diagnosis of any disorder manifested or, in the case that no diagnosis can be made, opine whether it is at least as likely as not (50 percent probability or greater) the Veteran’s symptom or symptoms are related to an undiagnosed illness or related to a medically unexplained chronic multi symptom illness. (ii) If the Veteran’s symptoms of joint pain of the bilateral hip, hand, foot, elbow and knees are related to a diagnosed disability, whether it is at least as likely as not (50 percent probability or greater) that any diagnosed disorder began in or is related to the Veteran’s active duty service. Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain and tingling 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 pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir., 2018). A complete rationale, with citation to appropriate medical principles, is requested. 5. Schedule the Veteran for an examination in order to determine the current level of severity of his left shoulder disability. The electronic claims folder and a copy of this remand must be made available to the examiner. The examination report should also include joint testing for pain on both active and passive motion, in weight-bearing and non weight-bearing, for both the joint in question and any paired joint. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. See Correia v. McDonald, 28 Vet. App. 158 (2016). 6. Thereafter, readjudicate the issues on appeal as noted above. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his representative should be afforded the applicable time period to respond. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Baskerville, LaRita 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.