Citation Nr: 21040734 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 16-52 124 DATE: July 6, 2021 REMANDED Entitlement to service connection for a bilateral foot disability is remanded. Entitlement to service connection for chronic fatigue syndrome (CFS) is remanded. Entitlement to service connection for fibromyalgia is remanded. Entitlement to a disability rating in excess of 10 percent prior to November 20, 2020, and to a disability rating in excess of 20 percent from that date for degenerative arthritis of the thoracolumbar spine is remanded. REASONS FOR REMAND The Veteran had periods of active service in the United States Army from June 1983 to June 1987 and from February 1988 to February 2007. These matters come before the Board of Veterans' Appeals (Board) on appeal from various rating decisions discussed in more detail to the extent that those procedural details are relevant to the decisions herein. These matters were previously before the Board in July 2019, when they were remanded for further development. Although the Board regrets the additional delay, for the reasons detailed below further development is still required for resolution of these matters. 1. Entitlement to service connection for a bilateral foot disability is remanded. The Board cannot make a fully informed decision on the issue of entitlement to service connection for a bilateral foot disability. In pertinent part, the January 2020 VA examination is not adequate because the examiner does not appear to have addressed the Veteran's hammer toe condition which is documented in the record beginning in September 2015. Additionally, in rendering the opinion, the examiner does not appear to have addressed the Veteran's assertion that his complaints of painful and swollen joints on the 2007 post-deployment health survey form from his final service period are early indications of the bilateral foot disability from which he currently suffers. The Veteran also appears to have asserted that his bilateral foot conditions are secondary to his service-connected back or associated lower extremity peripheral nerve conditions. In light of the foregoing, this matter must be remanded for an additional VA examination and appropriate opinions. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Colvin v. Derwinski, 1 Vet. App. 171 (1991). 2. The matters of (1) Entitlement to service connection for CFS and (2) Entitlement to service connection for fibromyalgia are remanded. The January 2020, November 2020, and December 2020 opinions and rationales provided are not sufficient to guide the Board in rendering a decision as to whether the Veteran's symptoms or complaints are the result of an undiagnosed illness or a medically unexplained chronic multi-symptom illness. The opinions that resulted from these examinations all indicate that the Veteran is not diagnosed with either CFS or fibromyalgia, and refer to the lack of a diagnosis for either of these conditions as the rationale for finding that the Veteran's claimed conditions are not the result of his service in Southwest Asia. However, these opinions do not address the question of whether the Veteran's complaints of chronic fatigue or chronic pain are symptoms of or are themselves an undiagnosed illness or medically unexplained chronic multi-symptom illness. Consequently, these matters must be remanded for additional opinions. 3. Entitlement to a disability rating in excess of 10 percent prior to November 20, 2020, and to a disability rating in excess of 20 percent from that date for degenerative arthritis of the thoracolumbar spine is remanded. VA treatment records received after the November 2020 VA lumbar spine examination indicate that the Veteran has complained of the effect of his lumbar spine condition on his sexual functioning. Consequently, this matter must be remanded for an addendum opinion indicating whether the sexual effects the Veteran was reporting are a neurological condition associated with the Veteran's service-connected lumbar spine condition. Therefore, this matter must be remanded for an additional opinion. The matters are REMANDED for the following actions: 1. Ask the Veteran to identify, and provide appropriate releases for, any care providers who may possess new or additional evidence pertinent to the issues on appeal. If he provides the necessary release(s), assist him in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact and the Veteran should be notified. 2. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 3. Schedule the Veteran for a VA examination for his claimed bilateral foot condition. The examiner must review the claims file, including the diagnoses of metatarsalgia, degenerative arthritis, and the Veteran's history of hammer toe. The examiner is asked to provide a response to the following: Are any of these disabilities at least as likely as not related to service, including the Veteran's 2007 report of swollen, stiff, or painful joints near the end of his final period of service? Additionally, are there medical reasons to believe that the Veteran's degenerative arthritis of bilateral foot either began during service or within one year of the end of his final period of service. Additionally, the examiner should provide an opinion as to whether it is at least as likely as not that any of the Veteran's bilateral foot conditions were caused or aggravated by the Veteran's service-connected lumbar spine and/or associated lower extremity peripheral nerve conditions. Provide a rationale to support the opinions. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's complaints of chronic fatigue and chronic pain (which he has called chronic fatigue syndrome and fibromyalgia) either are themselves or are symptoms of an undiagnosed illness or a medically unexplained chronic multi-symptom illness associated with service in Southwest Asia. This opinion should be rendered even though the Veteran has not been diagnosed with CFS or fibromyalgia, especially in light that this question specifically contemplates undiagnosed illnesses. In the event that these opinions cannot be provided without an additional examination, the Veteran should be scheduled for an appropriate examination. 5. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's recent reports of sexual function problems related to his lumbar spine condition are at least as likely as not symptoms of a neurological condition associated with his service-connected lumbar spine condition. In the event that this opinion cannot be provided without an additional examination, the Veteran should be scheduled for an appropriate examination. 6. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issues on appeal should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. John Kitlas Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Steven H. Johnston, 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.