Citation Nr: 18140072 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 15-35 193A DATE: October 2, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for an acquired psychiatric disorder to include posttraumatic stress disorder (PTSD), anxiety and depression is remanded. Entitlement to a higher initial rating for slight instability of the left knee, currently evaluated as 10 percent disabling, is remanded. Entitlement to a higher initial rating for slight instability of the right knee, currently evaluated as 10 percent disabling, is remanded. Entitlement to an increased rating for left knee chondromalacia patella and strain, currently evaluated as 10 percent disabling, is remanded. REASONS FOR REMAND Initially, based on evidence indicating that the Veteran has been diagnosed with anxiety and depression, the Board finds that the issue involving PTSD is properly characterized as entitlement to service connection for an acquired psychiatric disorder, to include PTSD, anxiety and depression, as reflected above. Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Veteran contends that these disorders resulted from four stressors which occurred in service: (1), witnessing a fatal traffic accident which occurred sometime between 1978 and 1980; (2), having to review line of duty reports which contained graphic pictures as a personnel action specialist from 1980 to 1990; (3), having to maintain order on the perimeter of a base in Stuttgart, Germany in 1990 where there were protestors who the Veteran feared might use weapons; and (4), witnessing two planes collide in mid-air on March 23, 1994 at Fort Bragg, North Carolina. See August 2012 claim. In support of these claims, the Veteran has submitted two private psychological evaluations where the same doctor appears to have attributed the Veteran’s PTSD and depression to the stressor involving maintaining order on the perimeter of a base in Germany and to the mid-air plane crash. See October 2013 private treatment record; September 2016 private treatment record. The Veteran has also submitted a statement from a buddy who served with the Veteran in Stuttgart, Germany and who attested to the Veteran appearing anxious and fearful since the time of the event. See October 2014 statement. Although an October 2013 memorandum essentially found that the stressor involving maintaining the perimeter could not cause an acquired psychiatric disorder, the Veteran has submitted medical evidence to the contrary as well as a corroborating buddy statement. Given that no VA examination has been obtained addressing the etiology of the Veteran’s current acquired psychiatric disorders, to include PTSD, depression and anxiety, one should be obtained on remand. See 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The memorandum notes, however, that although the RO requested that the Veteran provide additional details regarding the claimed stressors, the Veteran did not do so. To facilitate corroboration of the Veteran’s claimed stressors, the Veteran should return VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD, with sufficient detail. As to sleep apnea, the Veteran contends that sleep apnea began during service and treatment records show he has been diagnosed with such disorder. See August 2012 private treatment record; December 2013 VA treatment record. He has also submitted an October 2014 statement from his wife who states that during service, the Veteran began snoring and often stopped breathing, and that his symptoms have been the same since service. As a lay person, the Veteran’s wife is competent to report observable symptoms. Given the low threshold for obtaining a VA etiological examination, the Board finds that one should be obtained on remand. See 38 U.S.C. § 5103A (d); McLendon, 20 Vet. App. at 81. As to the knees, the Veteran was most recently provided with a VA contract examination in April 2014. Although the examiner conducted range of motion testing and indicated that there was evidence of pain, it is not clear whether the range of motion testing occurred in active or passive range of motion, in weight-bearing or in non-weight bearing. See Correia v. McDonald, 28 Vet. App. 158 (2016) (holding that 38 C.F.R. § 4.59 requires that an adequate VA examination of the joints must, wherever possible, include the results of the range of motion testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing). Accordingly, the Board finds that another examination is warranted. Any outstanding VA treatment records should also be obtained. The matters are REMANDED for the following action: 1. Associate with the claims file all outstanding VA treatment records, to include any records from Durham VA health Care System from July 2017 to the present. 2. Send the Veteran a VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD. The Veteran should also be asked to provide sufficient information to verify the four in-service stressors that he has reported (such as a description of the incident, the date, location, and names of any individuals injured or killed). Based on the information provided by the Veteran, conduct any development that may be necessary to verify any reported stressor. 3. Thereafter, schedule the Veteran for a VA examination regarding the etiology of any current acquired psychiatric disorder, to include PTSD, anxiety and depression. The examiner should review the file prior to the examination and indicate that such a review has taken place. The examiner should identify all current psychiatric conditions present, and for each identified psychiatric condition, including PTSD, anxiety and depression, the examiner should provide an opinion as to whether the identified psychiatric condition is at least as likely as not (50 percent or greater) related to the Veteran’s reported in-service stressors/in-service experiences. A complete rationale should be provided for all opinions. 4. Schedule the Veteran for a VA examination to address to the etiology of sleep apnea. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should indicate whether it is at least as likely as not (50 percent probability or more) that the Veteran’s sleep apnea is related to or had its onset during the Veteran’s period of active duty service. The examiner is advised that lay persons are competent to report observable symptoms and that such reports must be taken into account in formulating the requested opinion. A complete rationale should accompany any opinion provided. 5. Schedule the Veteran for a VA examination to evaluate the current severity of his left and right knee disabilities. The electronic claims folders should be made available to the examiner for review in conjunction with the examination and the examiner should acknowledge such review in the examination reports. Any indicated studies should be performed. The examination should be conducted in accordance with the current disability benefits questionnaire or examination worksheet applicable to the knees. The examiner should fully describe and distinguish any impairment arising from pain on active motion, passive motion, in weight-bearing, and in nonweight-bearing for the joints in question. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. A complete rationale should accompany any opinion provided. (Continued on the next page)   6. After completing any additional development deemed necessary, readjudicate the claims. If any benefit requested on appeal is not granted to the Veteran’s satisfaction, the appellant and his representative should be furnished a supplemental statement of the case, and provided an opportunity to respond. The case should then be returned to the Board for further appellate consideration, if in order. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Matthew Schlickenmaier, Counsel