Citation Nr: 21025225 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-19 735A DATE: April 27, 2021 REMANDED Entitlement to service connection for a bilateral knee condition is remanded. Entitlement to service connection for an acquired psychiatric disorder (other than service-connected schizophrenia) is remanded. Entitlement to service connection for a respiratory condition, to include as due to asbestos exposure, is remanded. Entitlement to service connection for a skin disorder, to include as secondary to service-connected schizophrenia, is remanded. Entitlement to service connection for high blood pressure is remanded. REASONS FOR REMAND The Veteran had active duty service from May 1996 to January 2006. He also had additional service in the Maryland National Guard with periods of active duty for training, to include from June 1993 to August 1993 and August 1994 to November 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the case for further development in October 2018. That development has been completed, and the case has since been returned to the Board for appellate review. 1. Entitlement to service connection for a bilateral knee condition The Board finds that an additional VA examination is required for the Veteran’s bilateral knee disorder claim. The Veteran was previously afforded a VA examination for this disorder in April 2016, wherein the VA examiner found no diagnosis. Review of VA medical records in evidence, however, shows that the Veteran has since been diagnosed with patellofemoral softening and patellofemoral maltracking of the right knee. Slight narrowing of each medial tibiofemoral joint was seen during a July 2019 x-ray. As such, the agency of original jurisdiction (AOJ) should obtain a VA addendum opinion for the Veteran’s knee disorder claim in order to address any possible diagnoses in evidence. 2. Entitlement to service connection for an acquired psychiatric disorder (other than service-connected schizophrenia) The Veteran was afforded an April 2016 VA psychiatric examination wherein no diagnosis was made. However, the Veteran’s medical records contain diagnoses including depression, anxiety, and mood disorder during the relevant appeal period. While the Board notes that the Veteran has since been granted service connection for schizophrenia at 100 percent, he has not withdrawn his appeal for service connection for an acquired psychiatric disorder (other than service-connected schizophrenia). As such, this issue remains on appeal and a VA addendum opinion is required. (Continued on the next page) 3. Entitlement to service connection for a respiratory condition, to include as due to asbestos exposure 4. Entitlement to service connection for a skin disorder, to include as secondary to service-connected schizophrenia 5. Entitlement to service connection for high blood pressure Regarding the Veteran’s claims for service connection for a respiratory disorder, a skin disorder and hypertension, a remand for additional development is needed to address the Veteran’s contentions that these disorders should be considered as a Gulf War Syndrome. See, e.g., March 2019 statement and notice of disagreement. The Veteran’s DD Form 214 reflects that he served in Kuwait from January 2004 to January 2005. Therefore, the Persian Gulf War provisions, 38 U.S.C. § 1117, 38 C.F.R. § 3.317, are applicable in this case. The Board also notes that an April 2016 VA examination for the Veteran’s respiratory claim attempted to address the Veteran’s contentions that his disorder was due to exposure from asbestos as a result of the brake shoes/pads that he handled in service. However, it is unclear from his September 2012 V Form 21-526 whether the Veteran was claiming exposure to asbestos due to handling brake pads, from working inside “class IX warehouses” or both. As such, upon remand, the AOJ should obtain a supplemental opinion for the Veteran’s respiratory disorder to address whether a respiratory disorder could have resulted from exposure to asbestos in class IX warehouses at Fort Hood. Additionally, the Board notes that the Veteran is now service connected for schizophrenia. VA medical records have indicated that the Veteran’s inability to maintain proper hygiene, due to his schizophrenia, is possibly causing issues with the Veteran’s skin. As such, the AOJ should obtain a medical opinion as to whether or not the Veteran has a skin disorder, to include psoriasis, that is caused or aggravated by his service-connected schizophrenia. Accordingly, the case is REMANDED for the following actions: 1. Provide the Veteran’s claims file to an appropriate clinician to provide an opinion regarding the Veteran’s bilateral knee disorder. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: Results of the March 2018 MRI (mild patellofemoral softening patellofemoral maltracking of the right knee) and the July 2019 x-ray results (slight narrowing of each medial tibiofemoral joint) The examiner must opine as to the following: (a.) Whether it is at least as likely as not that the Veteran’s current right knee disorder is causally or etiologically related to his military service, to include any injury or symptomatology therein. (b.) Whether it is at least as likely as not that the Veteran’s current left knee disorder is causally or etiologically related to his military service, to include any injury or symptomatology therein. Note - The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 2. Provide the Veteran’s claims file to an appropriate clinician to provide an opinion regarding the etiology of any acquired psychiatric disorder (other than service-connected schizophrenia) that may be present. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner must opine as to the following: (a.) Clarify whether the Veteran’s diagnoses of record (including depression, anxiety, and mood disorder) are separate and distinct from his service-connected schizophrenia. (b.) If so, whether it is at least as likely as not that the Veteran’s current acquired psychiatric disorder (other than service-connected schizophrenia) is causally or etiologically related to his military service, to include any injury or symptomatology therein. Note - The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. Provide the Veteran’s claims file to an appropriate clinician to provide an opinion regarding the Veteran’s claim for a respiratory condition. The entire claims file and a copy of this remand must be made available to the examiner for review. A new examination (physical or telehealth) is only required if deemed necessary by the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner must opine as to the following: (a.) Whether it is at least as likely as not that the Veteran’s diagnosis of asthma is causally or etiologically related to his military service, to include any injury or symptomatology therein or exposure to asbestos at class IX warehouses at Fort Hood or exposure to environmental hazards during his period of service in the Persian Gulf War. (b.) If the Veteran has any symptomatology that is not attributable to a known clinical diagnosis, whether such symptomatology is as likely as not due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness resulting from service in Southwest Asia during the Gulf War. Note - The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 4. The Veteran should be afforded an additional VA examination to determine the nature and etiology of any skin disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner must opine as to the following: (a.) Whether it is at least as likely as not that the Veteran has a current skin disorder that is causally or etiologically related to his military service, to include any injury or symptomatology therein. (b.) Whether it is at least as likely as not that the Veteran has a skin disorder that is either caused by his service-connected schizophrenia, which causes an inability to maintain proper hygiene. (c.) Whether it is at least as likely as not that the Veteran has a skin disorder that is aggravated by his service-connected schizophrenia, which causes an inability to maintain proper hygiene. (d.) If the Veteran has any symptomatology that is not attributable to a known clinical diagnosis, whether such symptomatology is as likely as not due to an undiagnosed illness or a medically unexplained chronic multi-symptom illness resulting from service in Southwest Asia during the Gulf War. Note - The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 5. The Veteran should be afforded a VA examination to determine the nature and etiology of any hypertension disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the appellant, the examiner should provide a fully reasoned explanation. The examiner must opine as to the following: (a.) Whether it is at least as likely as not that the Veteran has a current hypertension disorder that is causally or etiologically related to his military service, to include any injury or symptomatology therein. (b.) If the Veteran has any symptomatology that is not attributable to a known clinical diagnosis, whether such symptomatology is as least as likely as not due to any undiagnosed illness or a medically unexplained chronic multi-symptom illness resulting from service in Southwest Asia during the Gulf War. Note - The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 6. Then, review all examination reports and medical opinions provided to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures. (Continued on the next page)   7. Then, readjudicate the claims. If any decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. T. Blake Carter Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Rideout-Davidson, 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.