Citation Nr: 0814610 Decision Date: 05/02/08 Archive Date: 05/12/08 DOCKET NO. 06-18 469 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Jackson, Mississippi THE ISSUE Entitlement to service connection for a sleep disorder. REPRESENTATION Appellant represented by: American Red Cross ATTORNEY FOR THE BOARD L.M. Barnard, Senior Counsel INTRODUCTION The veteran served on active duty from November 2003 to March 2005. This appeal arose before the Board of Veterans' Appeals (Board) from a December 2005 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO), which denied entitlement to the benefit sought. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The evidence of record includes the veteran's service medical records. These showed that in November 2004, she was seen with complaints of sleepiness. She stated that she slept too much and could fall asleep anywhere. She also noted that she experienced enuresis about twice a month. Because of this sleepiness, she reported involvement in five motor vehicle accidents over the years. She reported 12 hours of sleep a night and her husband complained that she snored. The diagnosis was daytime somnolence and nocturnal enuresis. She was instructed on bladder exercises and was advised to sleep no more than 9 hours a night. She was also advised to undergo a sleep study once she had returned to Norfolk. A follow-up visit noted a diagnosis of hypersomnolence and nocturia of unknown origins. In January 2005, she was referred for a psychiatric evaluation; she reported being frustrated and depressed over the fact that her sleep disorder and bladder problems were not being handled properly. She was anticipating her release from the military so that she could join her husband in Mississippi. The assessment was occupational stressors. In January 2005, it was noted that there would be no further follow-up or additional testing for her sleep disorder due to the failure of behavioral techniques and no indication of any physiological etiologies. At the time of her separation examination conducted in January 2005, she reported that she had a sleep disorder in 1989, during high school. The impression was hypersomnulence that existed prior to her service. Following her separation from service, the veteran underwent a VA examination in October 2005. She reported that she had snored since the age of 13. She indicated that she still snored and that her husband complained about it. She had received no treatment for this snoring. She denied any apneic spells or sleep obstruction. She did report that she occasionally felt dizzy during the day, although she denied having any trouble sleeping, in maintaining sleep, or in getting up in the morning. About twice a month, she had enuresis, which she indicated had begun in April 2004; however, she denied having any bladder or kidney problems. She was referred for sleep studies, which were unremarkable. In November 2006, a VA examiner, without benefit of the claims file, noted that she did not have narcolepsy or cataplexy. The RO had determined that another VA examination was necessary. It was noted that the examiner in November 2006 had not reviewed the claims folder, which rendered the examination inadequate. It was also noted that, while sleep apnea and narcolepsy had not been diagnosed, there was no opinion as to whether or not the veteran had a sleep disorder related to the complaints during service. Additionally, while the veteran's service entrance examination had not noted any sleep disorder, she had stated during service that this difficulty had been present since high school. Moreover, the January 2005 separation examination had found that her "sleep disorder" had existed prior to her service. As a consequence, an examination was scheduled. The veteran had then contacted the RO and had requested that this examination be rescheduled because she could not report due to a prior commitment. The examination was rescheduled for August 2007. She failed to report. The veteran's representative has requested that, due to the complexity of the veteran's claim, another attempt be made to examine her. It was pointed out that she might uncomfortable and afraid to report; thus, it was requested that her husband be permitted to accompany her. The Board agrees that the veteran should be provided with one last opportunity to report for the needed examination. However, she is to be advised of the importance of reporting to this examination, and of the consequences of the failure to report. See 38 C.F.R. § 3.655 (2007). Accordingly, the case is REMANDED for the following action: 1. Schedule the veteran for all appropriate VA examinations needed to diagnose the veteran's condition and to render an opinion as to the etiology of any "sleep disorder." These should include a general medical examination, a psychiatric examination, and a sleep study, and any other examinations deemed necessary. The claims folder must be made available for the examiner(s) to review in conjunction with the examination(s), and the examiner(s) must indicate in the examination report(s) that the claims folder was so reviewed. The examination(s) should render a definitive diagnosis. The examiner(s) should also render an opinion as to whether it is at least as likely as not that any diagnosed disorder existed prior to her entry onto active duty. If the condition is found to have preexisted her service, the examiner(s) should render an opinion as to whether it is at least as likely as not that it increased in severity, beyond its natural progression, during service. If it is found that any diagnosed disorder had not preexisted service, the examiner(s) must render an opinion as to whether it is at least as likely as not that any such disorder is etiologically related to the complaints and symptoms noted in service. The examination(s) must include a complete rationale for all opinions expressed. 2. Once the above-requested development has been completed, the veteran's claim for service connection for a sleep disorder must be readjudicated. If the decision remains adverse to the veteran, she and her representative must be provided with an appropriate supplemental statement of the case, and an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2007). _________________________________________________ MARJORIE A. AUER Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2007).