Citation Nr: 22015737 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 17-57 250 DATE: March 18, 2022 REMANDED Entitlement to mixed connective tissue disease (MCTD) to include scleroderma, polymyositis and overlapping lupus is remanded. Entitlement to service connection for Raynaud's disease is remanded. Entitlement to service connection for atheromatous is remanded. Entitlement to service connection for multiple calcified granulomas in liver and spleen (also claimed as calcified intestinal fibrosis) is remanded. Entitlement to service connection for rheumatoid arthritis is remanded. REASONS FOR REMAND The Veteran, who is the appellant, served on active duty from October 1994 to February 1996. In July 2021, a videoconference board hearing was held before the undersigned. A transcript of the hearing is associated with the Veteran's claims file. At the hearing, the record was held open 60 days for the submission of additional evidence. In September 2021, the Veteran filed a motion for an extension of time. This was granted and the Veteran was provided an additional 90 days (until December 2021) to submit additional evidence. No additional evidence has been received. Entitlement to MCTD to include scleroderma, polymyositis and overlapping lupus; Raynaud's disease; atheromatous; multiple calcified granulomas in liver and spleen; and rheumatoid arthritis is remanded. The Veteran contends the disabilities for which he is claiming service connection are related to service or to his service-connected disabilities. The Veteran is currently service-connected for asbestosis, claimed as granuloma of the lungs, pulmonary hypertension, and restrictive ventilatory defect, rated 100 percent disabling; and mood disorder, with depressive features and anxiety disorder, rated 30 percent disabling. During the hearing on appeal, the Veteran testified that his disabilities were autoimmune diseases that were triggered by the asbestosis for which service connection has been established. In support this claim, a December 2015 statement has been received from the Veteran's chiropractor that included an opinion that the Veteran's poly-myositis, lupus, Raynaud's disease and rheumatoid arthritis are related to pulmonary hypertension that is related to the service-connected asbestosis. The rationale provided for this opinion was not specific and is not found to be adequate for rating purposes. In September 2015, a VA examiner stated that an opinion regarding whether the Veteran's claimed disabilities were due to asbestos exposure during service could not be made without resorting to speculation. The rationale was that the Veteran's multiple issues, including asbestosis exposure, Raynaud's disease, rheumatoid arthritis, and polymyositis were "all contributing to his severe disability." The Board does not find this rationale to be sufficient for rating purposes either. As no adequate rationale has been provided, an additional opinion is found to be necessary in this case. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: Schedule the Veteran for a VA examination for his MCTD to include scleroderma, polymyositis and overlapping lupus; Raynaud's disease; atheromatous; multiple calcified granulomas in liver and spleen; and rheumatoid arthritis. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: (a) Is it at least as likely as not that any of the claimed disabilities at issue (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? (b) Are any of the claimed disabilities at issue at least as likely as not proximately due to or at least as likely as not aggravated, i.e., worsened beyond its natural progression, by a service-connected disability? Provide a rationale to support the opinion(s). A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph P. Gervasio 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.