Citation Nr: 1318596	
Decision Date: 06/07/13    Archive Date: 06/11/13

DOCKET NO.  09-36 977A	)	DATE
	)
	)

On appeal from the
Department of Veterans Affairs Regional Office in St. Louis, Missouri


THE ISSUE

Entitlement to service connection for a disorder manifested by left leg calf muscle disorder/spasm, to include sleep apnea.


REPRESENTATION

Appellant represented by:	Disabled American Veterans


ATTORNEY FOR THE BOARD

J. Chapman, Associate Counsel


INTRODUCTION

The Veteran served on active duty from December 1987 to December 2007.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2008 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri.  

The Board notes that the Veteran also initiated appeals as to claims for service connection for migraine headaches and right hand or wrist disability, to include carpal tunnel syndrome.  However, he specifically limited his substantive appeal to the disability manifested by leg spasm.  The Board's decision will therefore be limited to the issue listed on the front page of this decision.

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 Veteran contends that he suffers chronic leg cramps as a result of service.  A May 2007 service treatment record noted pain on the medial side of the leg at night, which the physician noted feels more like a trigger point than restless legs.  On July 2007 separation report of medical history, the Veteran noted left leg jumps and calf muscle tightness.  

The Veteran was afforded a VA examination in February 2008.  He was diagnosed with nocturnal leg cramps.  An October 2009 statement from Sleep Diagnostic Services noted leg kicks and diagnosed sleep apnea.  In his substantive appeal, the Veteran contends that he has RLS (restless leg syndrome) which is a symptom of sleep apnea.  Thus, an opinion is necessary to address whether the Veteran's has a disability manifested by leg cramps, to include sleep apnea, which is related to service.  See McLendon v. Nicholson, 21 Vet. App. 79 (2006).

Accordingly, the case is REMANDED for the following:

1.  The RO should arrange for the Veteran's claims file to be forwarded to a medical provider for an advisory medical opinion regarding a nexus between the Veteran's in-service left leg and calf complaints and diagnosed nocturnal leg cramps associated with sleep apnea.  The examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that:
(a) the Veteran's sleep apnea either began during service or is otherwise related to military service; and 
(b) any other disability manifested by nocturnal leg cramps either began during service or was otherwise related to military service.  
The examiner should address the significance, if any, of the reports of leg cramps in service.  The opinion must be accompanied by a complete explanation of rationale.

2.  Then, re-adjudicate the claim.  If it remains denied, the RO should issue an appropriate supplemental statement of the case and afford the Veteran the opportunity to respond.  The case should then be returned to the Board, if in order, for further review.

The appellant has the right to submit additional evidence and argument on the matter 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 for additional development or other appropriate action must be handled in an expeditious manner.  See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012).


_________________________________________________
M.C. GRAHAM
Acting 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) (2012).