Citation Nr: 21026502 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 15-38 908A DATE: May 3, 2021 REMANDED Entitlement to service connection for a right shoulder disability. Entitlement to service connection for a right knee disability. Entitlement to service connection for a right thumb disability. Entitlement to service connection for migraine headaches. Entitlement to service connection for a sleep disorder. Entitlement to service connection for a dermatological disorder to include hair loss. Entitlement to service connection for a cardiovascular disability. Entitlement to service connection for bilateral carpal tunnel syndrome. Entitlement to service connection for eczema. REASONS FOR REMAND The Veteran served honorably on active duty from January 1988 to January 1992. The certificate of release from active duty (DD214) reveals that the Veteran received the Southwest Asia Service Medal. These matters come to the Board from a September 2013 rating decision. VA adjudicated these issues in prior rating decisions, but VA had not associated the Veteran's service treatment records with his file at the time. See February 2011 rating decision; June 2009 rating decision; January 2009 VA Memorandum (noting the service records were unavailable at the time). As VA has since received additional relevant service records containing evidence of in-service exposures to conditions in Southwest Asia not previously in the record, the Board will reconsider the claims in accordance with 38 C.F.R. § 3.156(c). In April 2012 , a VA examiner opined that the Veteran's disabilities were less likely as not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. In June 2019, the Veteran's attorney noted that the VA examinations failed to address every theory for service connection raised by the record including direct and secondary service connection. She also noted that the VA examiner did not address whether the Veteran's claimed disabilities were of unknown or partially unknown etiology. See Stewart v. Wilkie, 30 Vet. App. 383, 389 (2018). She noted that the VA examination reports did not discuss the etiologies of the claimed disabilities. She noted they did not address an etiological relationship with the Veteran's service-connected fibromyalgia. VA should obtain a new examination to address these concerns. In July 2013, a C&P Examination Note was associated with the claims file. Therein, the VA examiner noted that the Veteran reported five or six years of medical evaluations performed at Walla Walla VA Hospital in the early to mid-1990s. The examiner noted the records are not found available for review in file aside from an X-ray report. In September 2013, a VA Form 10-7131 was associated with the claims file. Therein, VA requested all archived non-electric treatment records at the Walla Walla VA Hospital, beginning in 1991. In September 2013, treatment records from the Walla Walla VA Hospital were associated with the claims file. The ten pages of treatment notations addressed the period between 1994 and 1996. VA should request the Veteran's assistance in identifying and obtaining all outstanding relevant records. The Board REMANDS for the following actions: 1. VA should ask the Veteran to identify outstanding relevant records from VA, federal, and private health care providers including outstanding records from the Walla Walla VA Hospital. VA should attempt to obtain the records and add them to the file. 2. After associating the outstanding records with the file, VA should obtain examinations from a medical professional regarding the Veteran's claims. The examiner should address the following concerns: (a.) The examiner should identify all disabilities and symptoms in regard to the Veteran's claims based on disabilities of the (i) right shoulder, (ii) right knee, (iii) right thumb, (iv) headaches, (v) sleep disturbances, (vi) hair loss (claimed as dermatology), (vii) cardiovascular disease, (viii) bilateral carpal tunnel syndrome, and (ix) eczema. The examiner should also consider any functional limitation due to pain to be a disability for the purpose of the examination. (b.) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) each disability (i) began during service, (ii) began within one year of separation from service, or (iii) was otherwise caused by events during military service. (c.) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's service-connected disabilities caused or aggravated each disability. Service-connected disabilities include major depressive disorder, fibromyalgia, and irritable bowel syndrome. The aggravation does not have to be permanent. Any incremental increase in the severity a disability (i.e. temporary worsening) caused by a service-connected disability may be a basis for secondary service connection. See Ward v. Wilkie, 31 Vet. App. 233 (2019). (d.) For each symptom, the examiner should opine as to whether the etiology and the pathophysiology of the symptom is partially understood. If either the etiology or pathophysiology is inconclusive, the examiner should state so. These opinions must be based on the Veteran's individual circumstances rather than the illnesses as they are understood in the general public. See Stewart v. Wilkie, 30 Vet. App. 383, 389 (2018). Michael Duffy Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board RLBJ, 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.