Citation Nr: 22015284 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 18-44 818 DATE: March 17, 2022 REMANDED Entitlement to service connection for a right hand condition is remanded. Entitlement to service connection for a right wrist condition is remanded. Entitlement to gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for a right ankle condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a left ankle condition is remanded. Entitlement to service connection for a left foot condition is remanded. Entitlement to service connection for a left arm condition to include the left elbow is remanded. Entitlement to service connection for a left hip condition is remanded. REASONS FOR REMAND The Veteran served with the Army National Guard from May 1990 to June 2017. He had Initial Entry Training (IET) from June 1990 to August 1990 and June 1991 to August 1991. He was mobilized from September 1999 to March 2000, February 2003 to May 2004, and May 2009 to July 2010. He also served on Active Guard Reserve (AGR) from November 2012 to December 2016. This matter is on appeal to the Board of Veterans' Appeals (the Board) from a November 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified in a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is in the evidence of record. At the hearing, the Veteran's motion to hold the record open for a period of 90 days for additional development was granted. In November 2021, the Veteran's representative submitted another 90-day extension request to obtain and submit additional evidence, which has expired and neither the Veteran nor his representative have submitted additional evidence. However, after a thorough review of the record, the Board finds that more development is necessary prior to final adjudication of the claims on appeal. 1. Entitlement to service connection for a right hand condition is remanded. The Veteran contends he is entitled to service connection for a right hand disability due to an in-service injury. During his August 2021 hearing, he testified to two separate injuries to the right hand and right wrist. He initially injured his hand in the early 2000s during a drill weekend. He reported jamming the hand into the forehead of another soldier, who was wearing a helmet. This happened at the very end of the drill weekend. A couple of days later when he could not move his hand, he went to the emergency room. At that time, he was told it was broken in three different places and placed in a cast. He never went for a formal line of duty (LOD) determination and paid for the medical costs himself. The Veteran testified to currently experiencing loss of control in the right hand and joint pain. He indicated the middle and index fingers were fixed together. He also reported that he attempted to get the emergency room records but was told records are purged after about 10 years. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge and experiences through his senses. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). In August 2007, his service treatment records noted a history of right wrist and fingers fracture. Giving the Veteran every benefit of the doubt, the Board finds he sustained an in-service injury to the right hand, which was not documented in his service treatment records. In November 2017, a VA examiner diagnosed the Veteran with a history of fourth metacarpal fracture with shortening, right side. He reported a history of hand fracture after crushing his hands against another soldier's helmet. He reported decreased range of motion in the right wrist with intermittent pain in his hand with flexion ever since. The examiner opined it was less likely than not that his right hand condition was incurred in or caused by the claimed in-service injury, event, or illness. His service treatment records contained no documentation to support a right wrist/hand injury as outlined by the Veteran. The Veteran's right wrist condition is related to his right hand condition without evidence of injury found in service. An addendum opinion is necessary to consider the Veteran's August 2021 hearing testimony. The examiner is advised the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such a rejection. Additionally, there appears to be outstanding treatment records. The record only contains VA treatment records from August 2010 to July 2017. During the August 2021 hearing, he testified to having a doctor's appointment scheduled for the right hand and receiving a referral from his primary care doctor. Later in his testimony he identified a Doctor Roth as his primary care physician (PCP). A June 2016 VA treatment note indicated Doctor Roth was the Veteran's non-VA PCP and that his care was co-managed through his private insurance with Providence. The record shows treatment records from Providence Medical Group Orenco from August 2014 to December 2016. Based on the Veteran's testimony, there appear to be outstanding treatment records. Therefore, on remand, appropriate steps should be taken to obtain any outstanding private and/or VA treatment records. 2. Entitlement to service connection for a right wrist condition is remanded The Veteran contends he is entitled to service connection for a right wrist disability due to an in-service injury. During his August 2021 hearing, he testified to two separate injuries to the right hand and right wrist. His right wrist injury occurred in the late 1990s or early 2000s when he attended the Non-Commissioned Officer Education System (NCOES) school. He indicated there was an LOD diagnosing a sprained wrist. He continues to experience pain and reduced range of motion in the wrist. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge and experiences through his senses. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). A May 2002 statement of medical examination and duty status noted a diagnosis of sprained right wrist due to an injury during battle drills in April 2002. In August 2007, his service treatment records noted a history of right wrist and fingers fracture. The right wrist fracture in 1999 was placed in a cast and resolved. In November 2017, a VA examiner diagnosed the Veteran with a chronic right wrist sprain. He reported breaking his right hand while doing combatives and was placed in a cast. Ever since this injury he noticed decreased range of motion in his wrist and fingers as well as the long and ring finger sticking together. Imaging revealed mild ulnar positive variance, small corticated ossified body dorsal to the carpal metacarpal joints on the lateral view, which might represent sequela of old trauma, and mild foreshortening of the fourth metacarpal that could be congenital. The examiner opined it was less likely than not that the right wrist condition was incurred in or caused by the claimed in-service injury, event, or illness. There was no documentation in the Veteran's service treatment records to support a right wrist/hand injury in service. His right wrist condition is related to his right hand condition without evidence of injury found in service. An addendum opinion is necessary to consider the Veteran's August 2021 hearing testimony. The examiner is advised the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such a rejection. Additionally, as discussed in detail above, there appear to be outstanding treatment records. On remand, appropriate steps should be taken to obtain any outstanding private and/or VA treatment records. 3. Entitlement to service connection for GERD is remanded. The Veteran contends he is entitled to service connection for GERD due to his service. During the August 2021 hearing, the Veteran testified his GERD symptoms started in the early 2000s during a deployment to Saudi Arabia. He was not a person who went to sick call and was not good about documenting things. However, he reported treating himself with tums for heartburn since the early 2000s. In 2019, it started to affect him more than it had before. He was taking sleeping pills since 2009 and did not notice how nauseous he felt laying down at night to sleep because he was falling asleep quickly. Currently, he must take tums every night. The Veteran also testified to being prescribed Omeprazole by his PCP. In November 2017, a VA examiner diagnosed the Veteran with GERD. He reported having heartburn and acid reflux for quite a while and estimated an onset in the early 2000s. He reported heartburn symptoms about three to four times a week. These symptoms were most pronounced when going to bed. The VA examiner opined the GERD condition was less likely than not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. GERD is not caused by a specific exposure event. The causes of GERD are primarily pathophysiologic, not due to external exposures in Southwest Asia. The most common pathophysiologic mechanisms include mechanical issues with the lower esophageal sphincter and anatomical disruptions around the lower esophageal sphincter. His service treatment records were silent for a GERD condition. The Veteran is competent to provide testimony concerning factual matters of which he has first-hand knowledge and experiences through his senses. Barr v. Nicholson, 21 Vet. App. 303 (2007); Washington v. Nicholson, 19 Vet. App. 362 (2005). Giving the Veteran every benefit of the doubt, the Board finds he first began experiencing GERD symptoms in service, which were not documented in his service treatment records. Therefore, an addendum opinion is necessary to consider the Veteran's August 2021 hearing testimony. The examiner is advised the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such a rejection. Additionally, as discussed in detail above, there appear to be outstanding treatment records. The Veteran also testified to current treatment with Omeprazole by his PCP. On remand, appropriate steps should be taken to obtain any outstanding private and/or VA treatment records. 4. Entitlement to service connection for a right ankle condition is remanded. 5. Entitlement to service connection for a right knee condition is remanded. 6. Entitlement to service connection for a left ankle condition is remanded. 7. Entitlement to service connection for a left foot condition is remanded. 8. Entitlement to service connection for a left arm condition to include the left elbow is remanded. 9. Entitlement to service connection for a left hip condition is remanded. The Veteran contends he is entitled to service connection for a right ankle condition, right knee condition, left ankle condition, left foot condition, left arm condition to include the left elbow, and left hip condition due to his service. The Board notes that the Veteran does not have current diagnoses of a right ankle condition, right knee condition, left ankle condition, left foot condition, left arm/elbow condition, or left hip condition. The November 2017 VA examiner opined there were no diagnoses because although there were symptoms there was no current clinical objective evidence of disease or pathology. As discussed in detail above, there are outstanding medical records that have not been associated with the claims file. Since the outstanding records might contain information probative to the Veteran's claimed right ankle condition, right knee condition, left ankle condition, left foot condition, left arm/elbow condition, or left hip condition, the Board finds that these issues are intertwined with the pending development to obtain any outstanding records. The matters are REMANDED for the following action: 1. Take appropriate steps to obtain any outstanding VA and non-VA treatment records. Request the Veteran identify all VA and non-VA health care providers including the name and address who have treated him during the pendency of this appeal. If the Veteran identifies a private provider, make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. Thereafter obtain an addendum opinion from the November 2017 VA examiner regarding service connection for the right hand condition. If the November 2017 VA examiner is not available, the opinion with rationale should be rendered by another qualified clinician. If, and only if, the examiner feels that a physical examination is needed, one should be scheduled. The reviewing clinician is asked to opine on the following: If it is at least as likely as not that his right hand condition had its onset in service or was otherwise etiologically related to any event or circumstance of his service. The examiner is asked to consider the Veteran's August 2021 hearing testimony. The examiner is advised the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such a rejection. The complete record, to include a copy of this remand and the claims folder, must be made available to and reviewed by the examiner in conjunction with the examination. The examination report must include a notation that this record review took place. 3. Obtain an addendum opinion from the November 2017 VA examiner regarding service connection for the right wrist condition. If the November 2017 VA examiner is not available, the opinion with rationale should be rendered by another qualified clinician. If, and only if, the examiner feels that a physical examination is needed, one should be scheduled. The reviewing clinician is asked to opine on the following: If it is at least as likely as not that his right wrist condition had its onset in service or was otherwise etiologically related to any event or circumstance of his service. The examiner is asked to consider a May 2002 statement of medical examination and duty status which noted a diagnosis of sprained right wrist due to an injury during battle drills in April 2002 as well as the Veteran's August 2021 hearing testimony. The examiner is advised the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such a rejection. The complete record, to include a copy of this remand and the claims folder, must be made available to and reviewed by the examiner in conjunction with the examination. The examination report must include a notation that this record review took place. 4. Obtain an addendum opinion from the November 2017 VA examiner regarding service connection for the Veteran's GERD. If the November 2017 VA examiner is not available, the opinion with rationale should be rendered by another qualified clinician. If, and only if, the examiner feels that a physical examination is needed, one should be scheduled. The reviewing clinician is asked to opine on the following: If it is at least as likely as not that his GERD had its onset in service or was otherwise etiologically related to any event or circumstance of his service. The examiner is asked to consider the Veteran's August 2021 hearing testimony. The examiner is advised the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such a rejection. The complete record, to include a copy of this remand and the claims folder, must be made available to and reviewed by the examiner in conjunction with the examination. The examination report must include a notation that this record review took place. 5. After completion of the above and any additional development deemed necessary to determine the nature and extent of any employment during the pendency of this appeal, the issue on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran and his representative should be furnished with a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for further consideration. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.L. Byers 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.