Citation Nr: 23017289 Decision Date: 03/20/23 Archive Date: 03/20/23 DOCKET NO. 19-02 098 DATE: March 20, 2023 REMANDED Entitlement to service connection for psoriatic arthritis is remanded. Entitlement to service connection for chronic joint pain is remanded. REASONS FOR REMAND The Veteran served on active duty with the U.S. Army from March 2000 to October 2001. He testified at a Board hearing in February 2022 before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. 1. Entitlement to service connection for psoriatic arthritis. 2. Entitlement to service connection for chronic joint pain. A review of the Veteran's treatment records show the Veteran has a diagnosis of psoriatic arthritis and has consistently reported joint pain. The Veteran is currently service connected for eczema/dermatitis that had its onset in service and has indicated that he experienced chronic pain since service. At the Board hearing he testified that a doctor informed him that his skin condition led to the development of psoriatic arthritis. Pursuant to a Board remand the Veteran was afforded examinations in September 2022. There are numerous opinions that were rendered by the September 2022 examiner. In one opinion, the examiner concluded psoriatic arthritis and/or chronic joint pain is less likely than not related to service, to include due to a skin condition. The examiner noted that chronic joint pain and eczema are not medically related and are separate entities. In another opinion, the examiner stated, "eczematous dermatitis with foot scarring as [a] medical association or risk factor associated with joint pain (psoriatic arthritis) conditions." These opinions are inadequate as they are contradictory. In a separate opinion, the examiner opined the Veteran's reported symptoms of joint pain during service are generally inconsistent with medical knowledge or implausible. A Veteran is competent to matters of which he has first-hand knowledge, to include observable symptomatology. As such, an opinion is needed addressing the Veteran's reports of joint pain. In another opinion the examiner noted the claimed condition was less likely than not incurred in or caused by an in-service injury, event, or illness. The rationale provided was the examiner was unable to diagnose a joint pain condition during service. This is inadequate rationale, as it relies on a lack of documentary evidence during service as the sole basis for a negative finding regarding a nexus. See Dalton v. Nicholson, 12 Vet. App. 23 (2007). Accordingly, an opinion is needed clarifying the etiology of the claimed psoriatic arthritis and chronic joint condition. The matters are REMANDED for the following action: 1. Obtain an addendum opinion as to the Veteran's psoriatic arthritis/chronic joint condition claim. The need for an in-person examination is left to the discretion of the examiner. Following a review of the claims file, the examiner should provide an opinion for the following: a) whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that psoriatic arthritis and/or chronic joint pain is related to his service? b) whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's psoriatic arthritis/chronic joint pain was caused or aggravated by his service-connected eczema? If aggravation is found, please identify to the extent possible the baseline level of disorder prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of psoriatic arthritis and/or joint pain, by eczema. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that determination an addendum opinion as to the Veteran's psoriatic arthritis and/or chronic joint pain claim. (Continued on the next page) The examiner is asked to provide a detailed rationale as to any opinion rendered. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Skiouris, 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.