Citation Nr: 21042733 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 14-06 926 DATE: July 13, 2021 REMANDED Entitlement to service connection for right side pain is remanded. Entitlement to service connection for fatigue is remanded. Entitlement to service connection for a lung condition is remanded. Entitlement to service connection for shortness of breath is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2002 to May 2002 and October 2003 to April 2005 in the United States Army, with subsequent service in the Army National Guard. 1. Entitlement to service connection for right side pain is remanded. 2. Entitlement to service connection for fatigue is remanded. 3. Entitlement to service connection for a lung condition is remanded. 4. Entitlement to service connection for shortness of breath is remanded. The claims must be remanded again because the VA medical opinions obtained to date are inadequate. The Veteran had active service in Southwest Asia between 2003 and 2005. Therefore, he is considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e). The Board notes that the evidence of record includes a Gulf War examination and the most recent VA medical opinion (October 2019) acknowledging that the claimed conditions do not have a confirmed separate diagnosis. Although the October 2019 examiner attributed these claimed conditions to manifestations of the Veteran's service-connected posttraumatic stress disorder (PTSD) with somatization disorder and anxiety disorder, the Veteran's representative argues that there has been no medical opinion on whether these claimed conditions represent an undiagnosed illness resulting from active service in the Persian Gulf. The Board finds that without the benefit of that medical opinion the October 2019 opinion is incomplete and therefore, inadequate to fully adjudicate the Veteran's claim. The October 2019 opinion needs to be further clarified in connection with connection between the claimed disabilities and the Veteran's service-connected PTSD. The October 2019 opinion provider said the right-sided pain, fatigue and shortness of breath are "part and parcel" of the service-connected PTSD with somatization disorder. It is unclear whether "part and parcel" refers to a condition for which either secondary service connection is warranted or it should be contemplated within the disability rating for the service-connected PTSD. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's right-side pain, fatigue, lung condition, and shortness of breath represent undiagnosed illness that is at least as likely as not etiologically related to his Gulf War active duty service. In answering this question, the examiner is asked to provide responses to the following: (a) With regard to a possible connection to service in Southwest Asia: A) Identify the Veteran's objective indications of a disability. "Objective indications" of a qualifying chronic disability include both objective evidence perceptible to an examining physician and other non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Non-medical indicators include evidence such as time lost form work, the veteran having sought treatment for his symptoms, and change in the veteran's appearance, physical abilities, and mental or emotional attitude. 60 Fed. Reg. 6661, 6663 (Feb. 3, 1995). B) By history, physical examination, or laboratory testing, can the Veteran's objective indications of a disability be attributed to a known clinical diagnosis? If the signs and symptoms are not characteristic of a known clinical diagnosis, the examiner should so indicate. There is no requirement that the examiner provide a diagnosis of undiagnosed illness. C) If the Veteran's objective indications cannot be attributed to a known clinical diagnosis, is there affirmative evidence that the undiagnosed illness is not incurred during active service during the Persian Gulf War or that it was caused by a supervening condition or event that occurred since the Veteran's departure from service during the Persian Gulf War? The examiner should note that a positive response to this question requires affirmative evidence. The mere absence of evidence is not sufficient. D) If the Veteran's objective indications can be attributed to a known clinical diagnosis, is the etiology of the Veteran's condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole. E) If the Veteran's objective indications can be attributed to a known clinical diagnosis, is the pathophysiology of the Veteran's condition (1) inconclusive, (2) partially understood, or (3) fully understood? This determination as to each must be based on the Veteran's specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. F) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran's diagnosed condition was incurred in, or is otherwise related to, his active service? (b) With regard to a connection to the already service-connected PTSD with somatization disorder: Clarify the August 2019 opinion that the right-sided pain, fatigue and shortness of breath are "part and parcel" of the service-connected PTSD with somatization disorder. Do the symptoms identified represent separately diagnosed disabilities or are the symptoms of the service-connected PTSD with somatization disorder? A complete rationale must be provided for all opinions expressed. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.