Citation Nr: 18140120 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 16-16 960 DATE: October 2, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a heart disorder, to include as due to exposure to herbicide agents, is remanded. Entitlement to service connection for a headache disorder, to include as secondary to service-connected posttraumatic stress disorder (PTSD) with depression, is remanded. REASONS FOR REMAND The Veteran had active service in the United States Navy from October 1965 to October 1967. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision. 1. Entitlement to service connection for sleep apnea is remanded. The AOJ has not yet obtained a VA examination related to the Veteran’s service connection claim for sleep apnea. The record reflects that the Veteran has a current diagnosis of sleep apnea. See November 2012 Private treatment record. The Veteran reported that he began to experience difficulty sleeping during service when he was exposed to constant "Harassment and Illumination (star burst)" fire that his ship provided for ground troops in Vietnam. See October 2014 Notice of Disagreement. In light of this evidence, the Board finds that a VA examination and medical opinion must be obtained. See McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006); Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (finding that when the medical evidence is insufficient, or, in the opinion of the Board, of doubtful weight or credibility, the Board must supplement the record by seeking an advisory opinion, ordering a medical examination, or citing recognized medical treatises that clearly support its ultimate conclusions). 2. Entitlement to service connection for a heart disorder, to include as due to exposure to herbicide agents, is remanded. The Veteran was provided with a VA examination addressing his service connection claim for a heart disorder in January 2016. The examiner gave a negative nexus opinion, stating that there was no documentation to support concluding that the Veteran’s heart disorder was caused by, or incurred during, his military service. In the absence of any further explanation, the Board finds that this opinion is inadequate. Thus, an additional medical opinion should be obtained on remand. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 3. Entitlement to service connection for a headache disorder, to include as secondary to service-connected PTSD with depression, is remanded. The Veteran has not yet been afforded a VA examination in connection with his service connection claim for a headache disorder. The record shows that he has a current diagnosis for tension headaches. See August 2012 Disability Benefits Questionnaire (DBQ). The record has also raised the theory that the Veteran’s tension headaches are secondary to his service-connected PTSD with depression. In completing an August 2012 DBQ for the Veteran’s claim, Dr. G. noted that additional diagnoses that pertained to the Veteran’s tension headaches included depression. In addition, a September 2012 VA treatment record noted the Veteran’s report that he could not tolerate Venlafaxine, an antidepressant medication, due to headaches. Consequently, the Board finds that the Veteran should be provided with a VA examination and medical opinion that addresses this theory upon remand. See McLendon, 20 Vet. App. at 83-86. The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his sleep apnea, heart disorder, and headache disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding, relevant VA medical records, to include records from the VA Greater Los Angeles Healthcare System dated since February 2015. 2. After the preceding development in paragraph 1 is completed, schedule a VA examination in relation to the Veteran's service connection claim sleep apnea. Any and all studies, tests, and evaluations deemed necessary should be performed. The examiner should review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. A clear explanation for all opinions based on specific facts of the case as well as relevant medical principles is needed. The Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptoms. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should clearly state whether the Veteran has a current diagnosis of sleep apnea. For any diagnosed sleep apnea, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the disorder manifested during service, or is otherwise related to service. 3. After the preceding development in paragraph 1 is completed, obtain a VA medical opinion from a qualified examiner on the etiology of the Veteran's heart disorder. The claims file must be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file. A clear explanation for all opinions based on specific facts for the case as well as relevant medical principles is needed. If an examination is deemed necessary, one must be provided. The examiner should identify all current heart disorders. For each identified disorder, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the disorder manifested during service, or is otherwise related to service. 4. After the preceding development in paragraph 1 is completed, schedule a VA examination in relation to the Veteran's service connection claim for a headache disorder. Any and all studies, tests, and evaluations deemed necessary should be performed. The examiner should review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. A clear explanation for all opinions based on specific facts of the case as well as relevant medical principles is needed. The Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptoms. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should identify all current headache disorders. For each identified disorder, the examiner should provide an opinion as to the following questions: (a) Whether it is at least as likely as not (50 percent probability or more) that the disorder manifested during service, or is otherwise related to service. (b) Whether it is at least as likely as not (50 percent probability or more) that the disorder was either caused by or aggravated by his service-connected PTSD with depression, to include any medications used to treat the psychiatric disability. (Continued on the next page)   In providing an opinion, the examiner should address the following: (1) the November 2012 VA treatment record’s report that the Veteran could not tolerate Venlafaxine due to headaches; and (2) the November 2012 DBQ for PTSD that noted the Veteran’s report of having several concussions that were occupationally related. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.C. Spragins