Citation Nr: 21029385 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 17-20 322 DATE: May 13, 2021 REMANDED Entitlement to service connection for neurological symptoms, to include twitching and/or muscle spasms, is remanded. Entitlement to service connection for an undiagnosed illness manifested by aching joints is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from May 1986 to May 1992. These matters come before the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In March 2021, the Veteran testified in a hearing before the undersigned Veterans Law Judge via videoconference. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for neurological symptoms, to include twitching and/or muscle spasms, is remanded. 2. Entitlement to service connection for an undiagnosed illness manifested by aching joints is remanded. Although it regrets the delay, the Board finds that a remand is necessary to allow further development before it can render a decision on the merits of the Veteran's appeal. Specifically, the Veteran must be afforded new a VA examination for his claimed disabilities; and nexus opinions for any documented disorder or symptomatology relevant to the appeal must be obtained. The Veteran contends, in pertinent part, that the disabilities on appeal are etiologically related to his military service in the Southwest Asia theatre of operations during the Gulf War, to include exposure to environmental hazards such as flea bites, toxins such as runoff from a depleted uranium ground tank, and fumes from burning crude oil and other objects/chemicals. See, e.g., VA examinations dated April 6, 1994 and April 26, 2016. Additionally, the Veteran asserts that he was required to take pyridostigmine as well as bromine shots laced with experimental nerve agents; and he maintains that his current symptoms may have been caused by such medication. See, e.g., VA examination dated April 26, 2016. A review of the record demonstrates that the Veteran was afforded a VA examination in April 2016 for the claimed conditions. At that time, a physician examined the Veteran and reported that the Veteran has (or has previously had) a diagnosis of a central nervous system disorder. See VA examination dated April 26, 2016. However, the examiner did not provide a specific diagnosis or indicate that the Veteran's symptoms are manifestations of an undiagnosed or unidentified illness. In light of this discrepancy, the Board finds the April 2016 examination to be inadequate for adjudicative purposes. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). During his March 2021 Board hearing, the Veteran testified that, within one year of his separation from service, he began experiencing neurological symptoms such as involuntary twitching of muscles in his fingers, hands, and back. See Board hearing transcript dated March 18, 2021 at 4-6; Notice of Disagreement (NOD) dated August 4, 2016; see also VA Form 9 dated April 14, 2017. He has further stated that his symptoms have gradually increased in severity since the April 2016 VA examination, such that he commonly experiences pain described as feeling like "needles [are] stuck in my fingers and my arms and my legs." See Board hearing transcript dated March 18, 2021 at 5. Concerning the condition affecting his joints, the Veteran has relayed that he first began experiencing joint soreness and pain within one year from his military discharge and that his symptoms have worsened over time, including since the April 2016 VA examination of the disability. See BVA hearing transcript dated March 18, 2021 at 9-10; see also VA Form 21-4138, Statement in Support of Claim, dated November 25, 1997. He has articulated that his current symptomatology includes severe aching of the joints in his arms and legs, described as sharp, stabbing pains. See NOD dated August 4, 2016; see also VA Form 9 dated April 14, 2017. Thus, the examination of record does appear to document the symptoms, and their severity, currently experienced by the Veteran. As a final matter, the Board observes that the evidentiary record does not contain nexus opinions regarding whether any diagnosed disabilities, or any reported symptoms attributable to an undiagnosed or unidentified condition relevant to the Veteran's claims, are at least as likely as not etiologically related to his military service. Therefore, a new VA examination is required to ascertain the nature and etiology of any pertinent disabilities or symptoms before the Veteran's claims can be properly adjudicated on their merits. Accordingly, the matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of any disability manifesting in symptoms such as involuntary twitching or muscle spasms and/or other neurological symptoms, in addition to any disability manifesting in soreness and pain of the joints of the upper and lower extremities, which may have resulted from the Veteran's military service, to include exposure to environmental hazards in Southwest Asia during the Persian Gulf War. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the examination. All necessary studies or tests must be performed, and their results documented in the record. After a thorough review of the Veteran's claims file, to include the Veteran's lay statements and the medical evidence relevant to the appeal, the examiner must address the following: (a.) Identify any disorders or illnesses manifesting in the symptomatology reported by the Veteran, including (i) involuntary twitching/muscle spasms and (ii) joint pain of the upper and lower extremities, such as wrists, elbows, knees, and ankles. (b.) For each diagnosed condition, is it at least as likely as not (50 percent probability or greater) that the condition is etiologically related to the Veteran's military service in the Persian Gulf, to include exposure to environmental hazards, noxious fumes emanating from burning objects/chemicals, and/or toxins such as uranium? (c.) If the examiner is unable to provide a known medical diagnosis for the Veteran's reported symptomatology, is it at least as likely as not (50 percent probability or greater) that the signs or symptoms experienced by the Veteran represent an objective indication of a medically unexplained chronic multi-symptom illness related to the Veteran's military service in the Persian Gulf? The examiner must provide a complete rationale for all opinions, citing to supporting clinical data and/or medical literature, as appropriate. The examiner is advised that the Veteran is competent to report in service and post-service symptomology. 2. After completing the requested action, and any additional action deemed necessary, readjudicate the claims. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and given the opportunity to respond before the claims are returned to the Board for further appellate review. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Tolbert, Associate 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.