Citation Nr: 21030963 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 11-13 492 DATE: May 20, 2021 ORDER Service connection for generalized arthritis, or other generalized pain disorder other than fibromyalgia or gout, is denied. Service connection for Achilles tendonitis is granted. REMANDED Service connection for a skin disorder other than dermatitis barbae is remanded. Service connection for a movement disorder, claimed as tremors, is remanded. FINDINGS OF FACT 1. The Veteran does not have a service-connectable generalized joint disorder. 2. The Achilles tendonitis began during service. CONCLUSIONS OF LAW 1. The criteria for service connection for a generalized pain disorder other than gout or fibromyalgia have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1117, 1118; 38 C.F.R. §§ 3.303, 3.317. 2. The criteria for service connection for Achilles tendonitis has been met. 38 U.S.C. § 1110, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from June 1992 to April 1994, including service in the Southwest Asia Theater of Operations during the Persian Gulf War. The Veteran provided testimony at a hearing before the undersigned Veterans Law Judge in October 2017. A transcript of the hearing is of record. For clarification purpose, the Board notes that although the March 2021 written brief presentation includes arguments pertaining to service connection for neuropathy, a claim for service connection for neuropathy is not on appeal before the Board. Notably, the Veteran did not submit a substantive appeal for the denial of neuropathy in the May 2017 Statement of the Case. Service Connection Service connection may be established for disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection may be granted to a Persian Gulf veteran who exhibits objective indications of chronic disability resulting from an undiagnosed illness or a medically unexplained chronic multi symptom illness (such as chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders ) that is defined by a cluster of signs or symptoms, or resulting from an illness or combination of illnesses manifested by one or more signs or symptoms, including signs or symptoms involving the respiratory system. The symptoms must be manifest to a degree of 10 percent or more. By history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. Objective indications of chronic disability include both "signs" in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. Disabilities that have existed for 6 months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a 6-month period will be considered chronic. 38 U.S.C. §§ 1117, 1118; 38 C.F.R. § 3.317. A Persian Gulf veteran is defined as a veteran who served on active duty in the Armed Forces in the Southwest Asia Theater of Operations during the Persian Gulf War. The Southwest Asia Theater of Operations include Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the air space above these locations. 38 C.F.R. § 3.317(d)(1)(2). 1. Generalized Arthritis The record indicates that service connection has been granted for fibromyalgia and that service connection was denied for gout in a now final decision. Notably, the Veteran did not submit appeal the denial of service connection for gout in the April 2009 Statement of the Case (SOC); he limited the appeal to other issues denied in the April 2009 SOC. Review of the record does not suggest the existence of another disorder manifest by generalized musculoskeletal pain. Notably, VA examination and treatment records have not diagnosed any such condition (again, other than gout or fibromyalgia), and the record indicates that the Veteran's reported widespread musculoskeletal pain is attributable to fibromyalgia. In sum, the Board finds no indication that the Veteran has a symptom or impairment other than that attributed to the fibromyalgia or gout. Thus, the claim is denied. 2. Achilles Tendonitis The record reveals diagnosis of Achilles tendon sprain/strain in May 1994 and tendonitis in July 2020. It also includes the Veteran's competent and consistent histories of symptoms of the Achilles tendons during and since service. Resolving all doubt in favor of the Veteran, the Board finds service connection is warranted for bilateral Achilles tendonitis. REASONS FOR REMAND The claim for service connection for a skin disorder other than dermatitis barbae is remanded. The record includes diagnoses of seborrheic dermatitis. In the March 2021 hearing brief, the Veteran's representative cited a study of Persian Gulf veterans from the United Kingdom which reported an unexplained two-fold increase in seborrheic dermatitis. The Board finds additional medical evidence is needed to address the study. The claim for service connection for a movement disorder is remanded. The record indicates that a December 2019 VA examiner Veteran diagnosed a movement disorder of essential tremors. However, a July 2020 VA examiner determined that the Veteran did not have essential tremors but did have fasciculations with dysesthesia. The Board finds the record would benefit if clarification were obtained to determine whether the Veteran as a movement disorder related to service. The matters are REMANDED for the following action: 1. Provide the claims file to the December 2019 VA examiner (or if unavailable an appropriate medical professional). After review, the medical professional should comment on whether the seborrheic dermatitis is at least as likely as not etiologically related to service. The medical professional must provide a rationale for all opinions expressed, with consideration of the medical study cited in the March 2021 appellate brief. If the medical professional is unable to provide any required opinion, the medical professional should explain why. If the medical professional cannot provide an opinion without resorting to mere speculation, a complete explanation as to why this is so should be provided. If the inability to provide a more definitive opinion is the result of a need for additional information, the additional information that is needed should be identified. 2. Obtain clarification from an appropriate medical professional as to whether the Veteran has a movement disorder. The medical professional should clarify whether the Veteran has essential tremors or fasciculations. The medical professional must provide a rationale for all opinions expressed, with consideration of the December 2019 and July 2020 VA examinations and the January 2009 and September 2014 determinations that at least some of the Veteran's reported neuromuscular symptoms were somatic manifestations of the service-connected psychiatric disability. If a movement disorder is diagnosed, the medical professional should then address whether it is etiologically related to the Veteran's Persian Gulf service. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Snyder, 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.