Case 26004789

Summary

The veteran, who served in the U.S. Marine Corps from November 1990 to May 1991, appeals the denial of service connection for several conditions. The veteran withdrew claims for liver, breast, right foot, and left foot disabilities, which were dismissed. The Board granted service connection for bilateral labyrinthine hypersensitivity and/or peripheral vestibular disorder, claimed as vertigo. The veteran's service treatment records were largely silent regarding vertigo, but the Board found the veteran's credible complaints of symptoms since service, coupled with post-service diagnoses of similar conditions, supported a finding of incurrence in service. The Board acknowledged negative VA medical opinions but found them inadequate because they did not accept the veteran's reported onset and continuity of symptoms. The Board granted service connection for vertigo, finding a nexus to service. Claims for joint and muscle pain were remanded for further development. The Board noted the complexity due to conflicting medical opinions and the need to investigate potential scleroderma, clarify the relationship between diagnosed conditions and fibromyalgia/chronic fatigue syndrome, and obtain adequate etiological opinions regarding the onset and nature of the veteran's musculoskeletal complaints, particularly in light of potential service-related exposures and physical training.

Full Decision Text

Citation Nr: 26004789
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 19-03 215
DATE: April 21, 2026

ORDER

Entitlement to service connection for a liver disability is dismissed.

Entitlement to service connection for a breast disability is dismissed.

Entitlement to service connection for a right foot disability is dismissed.

Entitlement to service connection for a left foot disability is dismissed.

Entitlement to service connection for bilateral labyrinthine hypersensitivity and/or a peripheral vestibular disorder, claimed as vertigo, is granted.

REMANDED

Entitlement to service connection for a disability characterized by joint pains is remanded.

Entitlement to service connection for a disability characterized by muscle pains is remanded.

FINDINGS OF FACT

1. During the Veteran's October 16, 2024, Department of Veterans Affairs (VA) Board of Veterans' Appeals (Board) hearing, prior to the promulgation of a decision in the appeal, he requested withdrawal of the appeal of his claims of entitlement to service connection for a liver disability, right and left foot disabilities, and a breast disability.

2. The Veteran has been diagnosed with bilateral labyrinthine hypersensitivity and/or a peripheral vestibular disorder.

3. The Veteran's labyrinthine hypersensitivity and/or a peripheral vestibular disorder had its onset in active service and has continued to manifest since that time.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of an appeal have been met with respect to the claims of entitlement to service connection for a liver disability, right and left foot disabilities, and a breast disability.  38 U.S.C. § 7105; 38 C.F.R. § 19.55.

2. The criteria for service connection for labyrinthine hypersensitivity and/or a peripheral vestibular disorder, claimed as vertigo, have been met.  38 U.S.C. §§ 1110, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Marine Corps from November 1990 to May 1991.  These matters come before the Board on appeal from a December 2015 VA Agency of Original Jurisdiction (AOJ) rating decision.  

The matters have been remanded by the Board to the AOJ for development in August 2019, March 2023, and, most recently, in February 2024.  The Veteran provided testimony at a hearing before the undersigned in October 2024.

The Veteran's claims of entitlement to service connection for bronchitis and entitlement to service connection for a persistent rash, addressed in prior Board remands, having been granted in full by the AOJ in an October 2023 rating decision, are no longer before the Board.  The Veteran's claim of entitlement to service connection for an immune disability, addressed in prior Board remands, is the subject of a modernized appeals system (AMA) appeal addressed by a separate Board decision.

Finally, the Board notes that following a July 2020 Statement of the Case in the Legacy system, in August 2020 the Veteran submitted a VA Form 10182 opting into the modernized appeals system (AMA).  However, the Board continued to address these claims in the Legacy system in the March 2023 and February 2024 remands, and they are again addressed herein.  Regardless of any error in this respect, because the Veteran has withdrawn these claims there is no prejudice to him.     

Withdrawal

1-4. Entitlement to service connection for a liver disability, right and left foot disabilities, and a breast disability.

The Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed.  38 U.S.C. § 7105.  An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  38 C.F.R. § 19.55.  Withdrawal may be made by the appellant or by his or her authorized representative.  Id.  Verbal withdrawal of a claim must be "explicit, unambiguous, and done with a full understanding of the consequences of such action."  Acree v. O'Rourke, 891 F.3d 1009, 1013-15 (Fed. Cir. 2018); DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see also Hansen v. Brown, 9 Vet. App. 29, 32 (1996) (holding the veteran validly withdrew his claim when "there [
.F.R. § 19.55.  Withdrawal may be made by the appellant or by his or her authorized representative.  Id.  Verbal withdrawal of a claim must be "explicit, unambiguous, and done with a full understanding of the consequences of such action."  Acree v. O'Rourke, 891 F.3d 1009, 1013-15 (Fed. Cir. 2018); DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see also Hansen v. Brown, 9 Vet. App. 29, 32 (1996) (holding the veteran validly withdrew his claim when "there [was] no indication that the veteran was misguided or lacked understanding of the consequences of his actions"). 

During the Veteran's October 16, 2024, Board hearing, he stated that he was withdrawing his appeal of the claims of entitlement to service connection for a liver disability, right and left foot disabilities, and a breast disability.  He expressed that he did so explicitly, unambiguously, and with a full understanding of the consequences.  The undersigned clearly identified the withdrawn issues and discussed that a withdrawal of such means that the claims are dropped, that they are no longer on appeal, and that they will no longer be addressed by the Board; the Veteran affirmed that he was requesting a withdrawal as to this appeal of these issues.  See Acree v. O'Rourke, 891 F.3d 1009 (Fed. Cir. 2018).

Accordingly, there remains no allegation of error of fact or law for appellate consideration with regard to the claims of entitlement to service connection for a liver disability, right and left foot disabilities, and a breast disability, and the aforementioned issues on appeal must be dismissed.  DeLisio, 25 Vet. App. at 57.

Service Connection

5. Entitlement to service connection for a disability manifested by vertigo.

Service connection generally will be awarded when a veteran has a disability resulting from disease or injury incurred in or aggravated by active service.  38 U.S.C. § § 1110, 1131; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).  

Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) incurrence or aggravation of a disease or injury in service; and (3) a link ("nexus") between the current disability and the disease or injury incurred or aggravated in service.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). 

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim.  38 U.S.C. § 5107; 38 C.F.R. § 3.102.  If the positive and negative evidence is in approximate balance-which includes but is not limited to equipoise-the claimant receives the benefit of the doubt.  Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).  If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply.  Id. at 781-82.

The Veteran, in his September 2014 claim, asserted entitlement to service connection for vertigo on the basis that such was caused by environmental exposure during service in Southwest Asia.  His service separation form, his DD-214, highlights his service therein from February 17, 1990, to April 6, 1991.  Very few service treatment records are available for review; such appear silent for complaint, treatment, or diagnosis of vertigo.  However, when service department records are lost or missing while in Government control, VA has a heightened duty to assist, and to consider the applicability of the benefit-of-the-doubt doctrine. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005); Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005).

During private treatment in July 2014, the Veteran reported vertigo, with an initial onset of 1993, with four-to
1990, to April 6, 1991.  Very few service treatment records are available for review; such appear silent for complaint, treatment, or diagnosis of vertigo.  However, when service department records are lost or missing while in Government control, VA has a heightened duty to assist, and to consider the applicability of the benefit-of-the-doubt doctrine. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005); Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005).

During private treatment in July 2014, the Veteran reported vertigo, with an initial onset of 1993, with four-to-five episodes weekly since.  The treatment provider found no true vertigo, noting the Veteran's feeling of lightheadedness and imbalance, with occasional tinnitus and a history of early ear infections as a child; the Veteran was diagnosed with bilateral labyrinthine hypersensitivity. 

Private treatment records dated in June 2014 indicate that the Veteran reported dizziness, with no known alleviating or exacerbating factors, occurring sometimes while driving and getting up from a seated position, with a history of treatment with medication during emergency room treatment for vertigo with vomiting 10 years prior, without continued treatment.  In July 2014, he was diagnosed with bilateral labyrinthine hypersensitivity, without true vertigo.  

During a September 2015 VA ear conditions Disability Benefits Questionnaire (DBQ), the Veteran was diagnosed with benign paroxysmal positional vertigo (BPPV); he reported the onset of such as 1993.  The examiner reported that the Veteran's disability pattern related to his vertigo was a diagnosable chronic multisymptom illness with a partially explained etiology, without further comment. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, will not be considered medically unexplained.  38 C.F.R.             § 3.317(a)(2)(ii).  

In a July 2020 private ear conditions DBQ, the Veteran was diagnosed with peripheral vestibular disorder; the reported the onset of such as 1993 with episodes of dizziness and imbalance, treated with medication. 

In a May 2023 VA ear conditions DBQ, the Veteran was diagnosed idiopathic vertigo; he reported the spontaneous onset of the same as 1987.  In August 2023, a VA examiner opined that it was less likely than not that the Veteran's claimed vertigo was related to in-service toxic exposures as the disability was an inner ear dysfunction. 

In a May 2024 VA ear conditions DBQ, the Veteran was diagnosed with bilateral labyrinthine hypersensitivity, with episodic dizziness and imbalance, of the same course, with an unknown onset, with tinnitus and vertigo.  In May 2024, the VA examiner opined that it was less likely than not that the Veteran's claimed vertigo was related to service, including exposures in Southwest Asia, as his service entrance examination was silent for vertigo and no evidence was found in his records.  The examiner opined that it was less likely than not that the Veteran's claimed vertigo was caused by such exposures, considering the total potential exposure through all applicable deployments and the synergistic combined effect of all toxic activities on the basis that there was no pathology to warrant a diagnosis or condition that can be related to the exposures.  

During the October 2024 Board hearing, the Veteran discussed that he started having headaches, dizziness, and blurry vision during his service in Southwest Asia, that he mentioned to a corpsman; he described exposure to a lot of smoke and artillery, with blowing up mine fields.  He reported that he sought treatment after separation from service and was diagnosed with vertigo, with a progressive course.

The Veteran has asserted that his symptoms of vertigo began during active service and continued since that time. See, e.g., Board Hearing Transcript, dated in October 2024.  While he has also placed the onset of his symptoms after service in 1993, the Board notes that this is not long after his separation from service in May 1991.  Regardless, the Board finds that the Veteran's statements describing vertigo symptoms during and ever since service are competent, as they are a matter of firsthand experience.  Resolving the benefit of the doubt in the Veteran's favor, the Board also finds that his statements are credible.  As noted above, when service department records are lost or missing while in Government control, VA has a heightened duty to consider the applicability of the benefit-of-the-doubt doctrine. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005); Washington v. Nicholson, 19 Vet. App. 362, 369-70 (
 not long after his separation from service in May 1991.  Regardless, the Board finds that the Veteran's statements describing vertigo symptoms during and ever since service are competent, as they are a matter of firsthand experience.  Resolving the benefit of the doubt in the Veteran's favor, the Board also finds that his statements are credible.  As noted above, when service department records are lost or missing while in Government control, VA has a heightened duty to consider the applicability of the benefit-of-the-doubt doctrine. See Cromer v. Nicholson, 19 Vet. App. 215, 217-18 (2005); Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005).  

While the Veteran was not diagnosed as having a disorder manifested by vertigo during service, his credible complaints of continuing symptoms since service and the post-service diagnosis of bilateral labyrinthine hypersensitivity and/or peripheral vestibular disorder based on similar symptoms support a finding that the disorder had its onset in service.  See 38 C.F.R. § 3.303(d).

Accordingly, the Board finds that the Veteran's bilateral labyrinthine hypersensitivity and/or a peripheral vestibular disorder, claimed as vertigo, was incurred in active service, and that a nexus to the current diagnosis is established.  Therefore, the criteria for service connection for bilateral labyrinthine hypersensitivity and/or a peripheral vestibular disorder are met.  See Holton, 557 F.3d at 1366.

The Board acknowledges the negative medical opinions of record.  However, it does not appear that the examiners accepted the Veteran's statements as to the onset and continuity of his vertigo symptoms since service to be true. Thus, the medical opinions are inadequate.  

Based on the foregoing, entitlement to service connection for bilateral labyrinthine hypersensitivity and/or a peripheral vestibular disorder, claimed as vertigo, is granted.

?

REASONS FOR REMAND

6-7. Entitlement to service connection for a disability characterized by joint pains and entitlement to service connection for a disability characterized by muscle pain.

The Veteran, in his September 2014 claim, asserted entitlement to service connection for joint and muscle pain on the basis that such was caused by environmental exposure during service in Southwest Asia.  As noted, very few service treatment records are available for review; such appear silent for complaint, treatment, or diagnosis of joint and/or muscle disabilities. 

During private treatment in September 2013, the Veteran reported myalgias and in May 2014, he reported intermittent leg cramps. 

Private treatment records dated in September 2013 indicate that the Veteran reported a flare of gout and requested medication.  Gout appears in the Veteran's private treatment problem list in May 2014.  

During a September 2015 VA fibromyalgia Disability Benefits Questionnaire (DBQ), the Veteran reported daily joint pain in the hands, elbows, shoulders, neck, back, and knees; the examiner noted a prior evaluation for gout with treatment and management and reported that the Veteran's disability pattern, including his claims related to joint and muscle pain, were diagnosable chronic multisymptom illnesses with partially explained etiology.  Chronic multisymptom illnesses of partially understood etiology and pathophysiology, will not be considered medically unexplained.  38 C.F.R. § 3.317(a)(2)(ii).  During a September 2015 VA chronic fatigue syndrome DBQ, the Veteran reported generalized muscle aches and weakness and migratory joint pains.

During private treatment in March 2016, the Veteran reported joint pain, myalgias, stiffness, and arthritis; his diagnoses included chronic fatigue syndrome.

November 2018 VA chronic fatigue syndrome, fibromyalgia, and muscle injuries DBQ reports indicate that the Veteran asserted that his fibromyalgia was the etiology of his muscle pain.

During private treatment in December 2019, the Veteran underwent injections for hyoid bone syndrome, with neck pain, his diagnoses included other specified disorders of the muscle.  The Board notes here that entitlement to service connection for hyoid bone syndrome has been separately claimed and denied by the AOJ in a March 2024 rating decision.  During private treatment in April 2020, the Veteran reported joint pain and was diagnosed with pain in an unspecified joint, under multiple pain, with evaluation underway for scleroderma. 

In a December 2020 VA fibromyalgia DBQ, the Veteran reported widespread musculoskeletal pain.  In a December 2020 VA chronic fatigue syndrome DBQ, the Veteran reported constant and extreme pain, all over this body. 

During private treatment in June 2021, the Veteran reported neck and back pain, magnetic resonance imaging (MRI) revealed degenerative disc disease of the lumbar spine and spondylosis of the
 has been separately claimed and denied by the AOJ in a March 2024 rating decision.  During private treatment in April 2020, the Veteran reported joint pain and was diagnosed with pain in an unspecified joint, under multiple pain, with evaluation underway for scleroderma. 

In a December 2020 VA fibromyalgia DBQ, the Veteran reported widespread musculoskeletal pain.  In a December 2020 VA chronic fatigue syndrome DBQ, the Veteran reported constant and extreme pain, all over this body. 

During private treatment in June 2021, the Veteran reported neck and back pain, magnetic resonance imaging (MRI) revealed degenerative disc disease of the lumbar spine and spondylosis of the cervical spine; he was diagnosed with sacrococcygeal disorders and lumbar spondylosis.  In January 2022, the Veteran reported neck pain and was diagnosed with cervicalgia and spondylosis, or cervical stenosis and disc degeneration. 

In a series of May 2023 VA DBQs, the Veteran was diagnosed with strain of the bilateral hands, bilateral shoulders, bilateral elbows, bilateral knees, lumbar spine, and cervical spine, all reported to have the same onset, 1990, resulting from physical training during service.

In a May 2023 VA muscle injury DBQ, no diagnosis was made.  The Veteran reported the onset of his condition as 1990, during strenuous physical training and tasks with heavy lifting.  In August 2023, a VA examiner reported that there was no diagnosed muscle injury since the symptoms were related to fibromyalgia.

In a May 2024 VA muscle injury DBQ, no diagnosis was made.  The Veteran reported the onset of symptoms as in October 2023 or November 2023, when he fell and hurt his knees; he reported that he was in bed for about a month and could not move his legs or stand.  In May 2024, a VA examiner opened that fibromyalgia is a disorder characterized by widespread musculoskeletal pain and can affect multiple joints and can cause generalized weakness, affecting all muscles at once or a particular muscle; the examiner repeated the same when asked to consider the Veteran's total potential exposure through all applicable deployments and the synergistic combined effect of all toxic activities.  The examiner stated that the Veteran's muscle pain and joint pain were due to fibromyalgia. 

In February 2025, a VA examiner opined that it was less likely than not that the Veteran's muscle pain was related to service, discussing that the Veteran was diagnosed with fibromyalgia which can cause musculoskeletal pain, and the diagnosis of scleroderma can also cause joint pain and muscle weakness, both of which can cause the muscle pain and are the more likely causes of such.  The examiner reported that there was no objective evidence showing a direct connection between the Veteran's claimed muscle pain and service, including his toxic exposures therein.  The examiner also opined that it was less likely than not that the Veteran's muscle pain was secondary to his service-connected fibromyalgia, repeating the same comment about the Veteran's fibromyalgia and scleroderma able to cause joint pain and muscle weakness, adding that such likely contributed to the development of muscle pain.  However, the examiner also reported that there is a secondary connection between the Veteran's muscle and joint pain as related to his fibromyalgia or another disability, the scleroderma, and a nexus had been established. 

In a March 2025 VA fibromyalgia DBQ, the Veteran was diagnosed with such and reported that his symptoms began with pain in his legs and feet, worsening and spreading diffusely to the entire body.  In March 2025, a VA examiner discussed that while scleroderma was noted, no positive test results for the same was of record, and that fibromyalgia and scleroderma are not medically related.  The examiner discussed that the Veteran relayed his muscle pain solely to fibromyalgia and his clinical findings in March 2025 were consistent with muscle and joint pain triggers with the diagnosis of fibromyalgia. 

In April 2025, a VA examiner explained that it was less likely than not that the Veteran has a distinct medical condition involving the joints and muscles which are secondary to service-connected fibromyalgia as joint and muscle pain are part of the disease process and a symptom set of fibromyalgia and do not represent a separate pathology or diagnosable condition.  The examiner discussed that, as noted in the prior fibromyalgia DBQ, symptoms of such include widespread musculoskeletal pain, stiffness, and weakness, as well as tenderness in all trigger points.  The examiner explained that it was less likely than not that the Veteran's muscle
 were consistent with muscle and joint pain triggers with the diagnosis of fibromyalgia. 

In April 2025, a VA examiner explained that it was less likely than not that the Veteran has a distinct medical condition involving the joints and muscles which are secondary to service-connected fibromyalgia as joint and muscle pain are part of the disease process and a symptom set of fibromyalgia and do not represent a separate pathology or diagnosable condition.  The examiner discussed that, as noted in the prior fibromyalgia DBQ, symptoms of such include widespread musculoskeletal pain, stiffness, and weakness, as well as tenderness in all trigger points.  The examiner explained that it was less likely than not that the Veteran's muscle aches and joint pain represent a disease process which is secondary to chronic fatigue syndrome as muscle pain is a symptom of chronic fatigue syndrome, as reported during the prior chronic fatigue syndrome DBQ as constant extreme pain all over the body with generalized muscle aches.  The examiner discussed that while reference was made to the Veteran having multiple joint pain with evaluation underway for scleroderma, a clear diagnosis of such is not of record.  The examiner concluded that the Veteran's joint and muscle pain are considered symptoms of fibromyalgia, with muscle pain also being a symptom of chronic fatigue syndrome, and there are no separate, secondary, diagnosable conditions. 

While these issues have been the subject of prior Board remands and the continued delay of the adjudication of the Veteran's claims is regrettable, additional development is required.

The issues have been complicated by the April 2020 private treatment records indicating that evaluation for scleroderma was underway; such was cited by the VA examiner in February 2025 in a discussion of the etiology of the Veteran's joint and/or muscle pains.  VA examiners, in March 2025 and April 2025, noted that results of any evaluation for scleroderma were not of record.  On remand, the AOJ should seek any outstanding private treatment records reflecting any evaluation for scleroderma.  

Further, prior Board remands have discussed that conclusions that the Veteran's joint and/or muscle pains are symptoms of his service-connected fibromyalgia and/or chronic fatigue syndrome based on the fact that fibromyalgia and/or chronic fatigue syndrome can or are known to cause joint and/or muscle pain are inadequate upon which to the adjudicate the claims and fail to consider the Veteran's particular circumstances.  One VA examiner, in March 2025, has provided specific rationale related to the Veteran's particular circumstances, basing their opinion that the Veteran's joint and/or muscle pains are symptoms of his service-connected fibromyalgia on the basis that his clinical presentation was consistent with muscle and joint pain triggers for fibromyalgia. 

However, the issue of whether the Veteran has scleroderma, and if so, whether such requires consideration in any etiological opinion related to his claims of entitlement to service connection for disabilities characterized by joint pain and muscle pain, respectively, and the March 2025 VA opinion is thus inadequate.

Finally, the AOJ afforded the Veteran the series of cited May 2023 DBQs related to his joints, reflecting strain of the bilateral hands, bilateral shoulders, bilateral elbows, bilateral knees, lumbar spine, and cervical spine.  Of record is also the September 2015 VA fibromyalgia DBQ wherein the Veteran reported daily joint pain in the hands, elbows, shoulders, neck, back, and knees and the examiner noted a prior evaluation for gout with treatment and management.  Also of record are the Veteran's private treatment records dated in June 2021, reflecting the Veteran's degenerative disc disease of the lumbar spine and spondylosis of the cervical spine, as well as sacrococcygeal disorders and lumbar spondylosis, and private treatment records dated in January 2022, reflecting the Veteran's cervicalgia and spondylosis, or cervical stenosis and disc degeneration.  Thus, any VA etiological opinion of record finding that the Veteran's joint and/or muscle pains are symptoms of his service-connected fibromyalgia and/or chronic fatigue syndrome, without consideration of the diagnosed joint and/or muscle disabilities of record, attributed to service by the Veteran, as well as any gout and/or immune or autoimmune disability, are inadequate.  On remand, the AOJ should obtain adequate VA etiological opinions.

The matters are REMANDED for the following action:

1. Ask the Veteran to identify and authorize VA to obtain any outstanding private treatment records reflecting any evaluation for scleroderma.  Make two requests for any authorized records unless it is clear after the first request that a second request would be futile.

2. Then, schedule the Veteran for a VA examination for his claimed joint and/or muscle pains.
 pains are symptoms of his service-connected fibromyalgia and/or chronic fatigue syndrome, without consideration of the diagnosed joint and/or muscle disabilities of record, attributed to service by the Veteran, as well as any gout and/or immune or autoimmune disability, are inadequate.  On remand, the AOJ should obtain adequate VA etiological opinions.

The matters are REMANDED for the following action:

1. Ask the Veteran to identify and authorize VA to obtain any outstanding private treatment records reflecting any evaluation for scleroderma.  Make two requests for any authorized records unless it is clear after the first request that a second request would be futile.

2. Then, schedule the Veteran for a VA examination for his claimed joint and/or muscle pains.  The examiner must review the claims file, perform all indicated tests and studies, and provide fully reasoned etiological opinions, providing a complete explanation in support of the conclusions reached, as to the Board's inquiries.

(a) Confirm the presence of scleroderma if possible, by the evidence of record, and if present, specifically discuss the relevance of such in light of the VA examiner's February 2025 notation of such related to the etiology of the Veteran's joint and/or muscle pains. 

(b) Identify all bilateral hand, bilateral shoulder, bilateral elbow, bilateral knee, lumbar spine, and cervical spine disorders found to be present.

(c) For Veteran's diagnosed gout and strain in the bilateral hands, bilateral shoulders, bilateral elbows, bilateral knees, lumbar spine, and cervical spine, as well as any other disability related to the spine, including, but not limited to, degenerative disc disease of the lumbar spine and spondylosis of the cervical spine, sacrococcygeal disorders, lumbar spondylosis, cervicalgia, cervical spondylosis, cervical stenosis, and cervical disc degeneration, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that such are related to service, specifically considering and discussing the Veteran's report of the onset of symptoms of such in 1990, during service, with the same course since, resulting from physical training, as well as his specific assertion of performing strenuous tasks with heavy lifting? 

(d) With respect to gout, the examiner should also provide an opinion as to whether it is as least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to any incident of service, specifically considering and discussing the Veteran's conceded Toxic Exposure Risk Activity (TERA), including, but not limited to, exposure to smoke, artillery, and blown-up mine fields, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of TERA.  

(e) For any remaining joint and/or muscle pain (not a symptom of gout and/or any diagnosed strain of the bilateral hands, bilateral shoulders, bilateral elbows, bilateral knees, lumbar spine, and cervical spine, or spondylosis of the cervical spine, sacrococcygeal disorders, lumbar spondylosis, cervicalgia, cervical spondylosis, cervical stenosis, and cervical disc degeneration), is it at least as likely as not that such represents symptoms of:  (1) service-connected fibromyalgia; and/or (2) service-connected chronic fatigue syndrome? 

3. Following the above development, and any additional development that may be warranted, readjudicate the claims for service connection for a disability characterized by joint pains and for a disability characterized by muscle pain.  If the benefits sought are not granted, provide the Veteran and his representative, if any, with a Supplemental Statement of the Case.

 

P.M. DILORENZO

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Anderson, Megan

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. 


3.