Citation Nr: 22012806 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 18-00 657 DATE: March 7, 2022 REMANDED Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as due to an undiagnosed Gulf War illness, is remanded. Entitlement to service connection for chronic fatigue syndrome, to include as due to an undiagnosed Gulf War illness, is remanded. Entitlement to service connection for headaches, to include as due to an undiagnosed Gulf War illness, is remanded. Entitlement to service connection for diverticulitis, to include as due to an undiagnosed Gulf War illness, is remanded. Entitlement to service connection for joint pain, to include bilateral knee and/or right shoulder disabilities, and to include as due to an undiagnosed Gulf War illness, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from January 1991 to March 1991, including service in Southwest Asia. In September 2021, the Veteran testified at a virtual hearing before the undersigned, and a transcript of that hearing is of record. 1. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities is remanded. 2. Entitlement to service connection for chronic fatigue syndrome is remanded. In January 2013, the Veteran had a VA peripheral nerve conditions examination, in which he was diagnosed with bilateral lower extremity peripheral neuropathy of the external cutaneous nerves. The examiner opined that the condition was "clearly related to be being overweight" and had no association with prior Persian Gulf military experience. The Veteran had a VA chronic fatigue syndrome examination in February 2013, in which the examiner concluded that the Veteran did not have chronic fatigue syndrome. In the September 2021 Board hearing, the Veteran asserted that his private doctor said he thought that the Veteran's peripheral neuropathy was due to environmental exposures in the Persian Gulf, and that he has a diagnosis of chronic fatigue syndrome. The file currently contains private treatment records dated through January 2012, and do not contain records related to the claimed peripheral neuropathy or chronic fatigue syndrome. As such, remand is necessary to obtain any outstanding treatment records. 3. Entitlement to service connection for headaches is remanded. In January 2013, the Veteran had a VA headaches examination. The examiner indicated that the diagnosis was headaches. The examiner noted that the Veteran's headaches had never been properly evaluated, that headaches were common and could be caused by numerous conditions, and that headaches were not migraines. The examiner also noted, however, that the Veteran had characteristic prostrating attacks of migraine headache pain that occurred less than once every two months on average. No explanation was provided regarding why the Veteran was not diagnosed with migraine headaches, despite the finding that he had characteristic prostrating attacks of migraine headache pain. As such, remand for a medical opinion addendum is necessary. 4. Entitlement to service connection for diverticulitis is remanded. In a series of January 2013 VA examinations, the Veteran was diagnosed with irritable bowel syndrome and diverticulitis. However, no opinion was provided on the nexus of either diagnosis. As such, the Board finds that a medical opinion should be obtained to determine the nature and etiology of the irritable bowel syndrome and diverticulitis. 5. Entitlement to service connection for joint pain is remanded. The Veteran initiated a claim for entitlement to service connection for "joint pain." In the September 2021 Board hearing, he asserted that he was specifically referring to his bilateral knees and right shoulder. He stated that he noticed pain beginning in approximately 2000, and that he used over-the-counter medication, such as Tylenol and Aleve, but the pain progressed quickly to the point that he needed something stronger. Service treatment records (STRs) from the Navy Reserve indicate that in September 1989, the Veteran reported having discomfort in his right knee; and in September 1991, he was noted to have a history of recurrent knee problems after running. Post-service treatment records indicate that the Veteran was found to have a history of a shoulder surgery sometime prior to December 2010, left knee patellofemoral syndrome in 2010, right knee degenerative changes in 2011, and left knee ostearthritis and meniscus tear in 2012. As such, the Board finds that the evidence of record supports the need for VA medical opinions on the issues. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), 38 U.S.C. § 5103A(d). The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide sufficient information, and if necessary, authorization to enable the AOJ to obtain any relevant outstanding non-VA treatment records, to include treatment records from Dr. Groning and/or Dr. Angelo. The AOJ should make an attempt to obtain any treatment records identified by the Veteran that are not currently associated with the claims file. 2. Contact the VA examiner who provided the January 2013 headaches opinion (or if he or she is no longer available, a suitable replacement) and ask the examiner to review the record and prepare an addendum to the medical opinion. All diagnoses relevant to the claimed headaches, to include discussion of whether the Veteran has a diagnosis of migraine headaches, should be noted. The examiner should opine on whether it is at least as likely as not (50 percent probability or greater) that any current headache condition is related to incident, injury, or event in active service, including service in the Southwest Asia (SWA) theater of operations during the Persian Gulf War. The examiner should specifically address the Veteran's contentions that he began getting "excruciating" headaches after he returned home from service, and they were not like "normal headaches." See the September 2021 Board hearing transcript. The Board's reference to evidence in this context should not be construed as a determination of its credibility. See Smith v. Wilkie, 32 Vet. App. 332 (2020). The examiner should explain the medical basis for the conclusions reached. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general, or if there is evidence that, if obtained, would permit the opinion to be provided. If the VA examiner determines that further examination is necessary in order to render the requested medical opinion, the Veteran should be scheduled for such an examination. 3. Contact the VA examiner who complete the January 2013 VA gastrointestinal conditions examination (or if he or she is no longer available, a suitable replacement) and ask the examiner to review the record and prepare a medical opinion. The examiner should opine on whether it is at least as likely as not (50 percent probability or greater) that any current diagnosis, including irritable bowel syndrome and/or diverticulitis, is related to incident, injury, or event in active service, including service in the SWA theater of operations during the Persian Gulf War. The examiner should specifically address the Veteran's contentions that he began having problems when he was approximately 28 or 29 (in 1996 or 1997), and that no one is his family has irritable bowel syndrome. The Board's reference to evidence in this context should not be construed as a determination of its credibility. See Smith v. Wilkie, 32 Vet. App. 332 (2020). The examiner should explain the medical basis for the conclusions reached. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general, or if there is evidence that, if obtained, would permit the opinion to be provided. If the VA examiner determines that further examination is necessary in order to render the requested medical opinion, the Veteran should be scheduled for such an examination. 4. Send the claims file to an appropriate VA examiner and ask the examiner to review the record and prepare a medical opinion on the etiology of the claimed joint pain, to include the bilateral knees and right shoulder. After reviewing the entire record, the examiner should note any current diagnosis relevant to the claimed joint pain. For each diagnosis, the examiner should provide a medical opinion on whether it is at least as likely as not (50 percent probability or greater) that the diagnosis is related to incident, injury, or event in active service, including service in the SWA theater of operations during the Persian Gulf War. The examiner should specifically address Navy Reserve records noting right knee pain after running. The examiner should explain the medical basis for the conclusions reached. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain whether the inability is due to the limits of the examiner's medical knowledge, medical knowledge in general, or if there is evidence that, if obtained, would permit the opinion to be provided. If the VA examiner determines that further examination is necessary in order to render the requested medical opinion, the Veteran should be scheduled for such an examination. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Nelson 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.