Citation Nr: 21029391 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-35 571 DATE: May 13, 2021 REMANDED Entitlement to service connection for musculoskeletal pain of the right lower extremity is remanded. Entitlement to service connection for musculoskeletal pain of the left lower extremity is remanded. Entitlement to service connection for fibroids is remanded. Entitlement to an initial rating in excess of 10 percent for idiopathic constipation is remanded. REASONS FOR REMAND The Veteran had active military service from October 1989 to April 1990, and from September 1996 to July 1998. She testified before the undersigned Veterans Law Judge during a March 2021 hearing. This matter is on appeal from April 2014 and May 2015 rating decisions. 1. Entitlement to service connection for musculoskeletal pain of the right and left lower extremities The Board of Veterans' Appeals (Board) cannot make a fully-informed decision on the issues of service connection for musculoskeletal pain of the bilateral lower extremities because the Veteran has not been provided a VA examination. She testified that she has had musculoskeletal pain since 1997. The Veteran is currently service-connected for right knee, left shin splints with slight left knee instability, and left hip disabilities. See January 2021 rating decision. It is not clear if she has other diagnoses to account for her musculoskeletal pain other than her service-connected disabilities. It is also not clear that any other diagnoses are related to service. A remand is necessary to provide her with an examination. 2. Entitlement to service connection for fibroids The Board cannot make a fully-informed decision on the issue of service connection for fibroids because the Veteran has not been provided a VA examination. Her service treatment record (STRs) appear to show "abdominal fibroids" in May 1997. The Board notes that the record is handwritten and not clearly legible. Treatment records during this appeal show diagnoses of uterine fibroids. See, e.g., October 2015 record. A remand is necessary to provide her with an examination. 3. Entitlement to an initial rating in excess of 10 percent for idiopathic constipation During her March 2021 testimony, the Veteran asserted that her idiopathic constipation has increased in severity since she was last examined by VA. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of this disability. The matters are REMANDED for the following action: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran, including any outstanding VA treatment records. 2. Schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any diagnosed musculoskeletal pain of the bilateral lower extremities. The most up-to-date Disability Benefits Questionnaire should be utilized. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. For any musculoskeletal pain of the bilateral lower extremities diagnosed, the examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnoses are related to the Veteran's military service. A complete rationale should be given for all opinions and conclusions expressed. The examiner should consider the Veteran's reports of pain that began in service and continued to the present. The examiner is reminded that the Veteran is competent to report having pain since service without corroborating evidence. The examiner is also reminded that the absence of "chronicity of care," in and of itself, is not a valid basis for a negative medical conclusion. If no bilateral lower extremity musculoskeletal disorder is diagnosed other than the service-connected right knee, left shin splints with slight left knee instability, and left hip disabilities, and if any reports of pain do not reach the level of a functional impairment of earning capacity, as defined in Saunders v. Wilkie, 886 F.3d. 1356 (Fed. Cir. 2018), the examiner should so state. 3. Schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any diagnosed fibroids. The most up-to-date Disability Benefits Questionnaire should be utilized. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. For any fibroids diagnosed, the examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnoses are related to the Veteran's military service. A complete rationale should be given for all opinions and conclusions expressed. The examiner should consider the apparent diagnosis of fibroids in May 1997 during the Veteran's military service. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected idiopathic constipation. The most up-to-date Disability Benefits Questionnaire should be utilized. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. All opinions must be supported by a rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Barstow, 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.