Citation Nr: 18141062 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 16-12 557 DATE: October 9, 2018 REMANDED Entitlement to service connection for a disability manifested by fatigue is remanded. Entitlement to service connection for sarcoidosis is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran claims service connection is warranted for a disability manifested by fatigue, for sarcoidosis, and for obstructive sleep apnea. In February 2016, he reported having no symptoms of any of these disorders prior to his active service, but having symptoms of all three after. While the Board sincerely regrets the delay, due to deficiencies in the development of these claims, remand is necessary. Examinations When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Here, the Veteran was afforded a VA Gulf War General Medical Examination as well as a VA examination related to sleep apnea in August 2013. With regard to the Veteran’s reported chronic fatigue, the Regional Office (RO), in the December 2015 statement of the case, suggested that an August 2013 VA examiner found no link between the Veteran’s fatigue and his military service ending in July 1993. The Board has reviewed the August 2013 VA examination report. In the medical history section, the examiner indicated “no answer provided” for every symptom. The only use of the word “fatigue” in the report is a single notation of the fatigue associated with sleep apnea. The Gulf War General Medical Examination is entirely devoid of mention of the Veteran’s reported chronic fatigue and, contrary to what is reported in the statement of the case, there is no opinion related to the Veteran’s fatigue. Because the Veteran reports the onset of fatigue following his return from service in the Persian Gulf, the Board finds a remand is necessary in order to afford him an examination related to that claim, as it appears one has not actually occurred. As to the Veteran’s sarcoidosis, the VA examiner noted the Veteran’s history and diagnosis of sarcoidosis, but then merely stated it is less likely as not that the sarcoidosis was caused by or incurred in his active service. There was no obvious rationale provided for this opinion. A remand is required for another opinion to be obtained. With regard to the sleep apnea claim, the examiner noted a date of diagnosis of 1991, chronicled the Veteran’s report of in-service symptoms, and then noted 2005 and 2008 sleep tests with later diagnoses. The examiner concluded that it is less likely as not that the Veteran’s obstructive sleep apnea was caused by or incurred in his military service, including during the Gulf War service. No obvious rationale was provided. Because no factual basis was provided for the dates of diagnosis listed and no rationale was provided for the opinion presented, this examiner’s opinion is inadequate. Remand is required in order to afford the Veteran a new examination and obtain another opinion. Records The Veteran’s claims file includes VA treatment records from the Montgomery VA Medical Center (VAMC) dated from June 2009 to August 2009. However, the December 2015 statement of the case indicates the RO reviewed records from the Birmingham VAMC dated May 3, 1999, as well as records from the Montgomery VAMC from October 7, 1997, through August 15, 2013. The August 2013 VA examiner also referenced various dates of diagnosis and noted a review of the VA treatment records. Thus, it appears certain that there are VA treatment records related to the claims on appeal that exist, but have not been associated with the claims file. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issues on appeal. A remand is required to allow VA to obtain them. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records related to his claims for service connection for a disability manifested by fatigue, for sarcoidosis, and for obstructive sleep apnea, dating since the Veteran’s July 1993 separation from active service, from the Birmingham and Montgomery VAMCs and any other VA healthcare facility from which the Veteran received treatment. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any disability manifested by chronic fatigue. The examiner should account for the Veteran’s reported history of symptoms. The examiner should render an opinion as to whether it is at least as likely as not (a 50 percent or greater possibility) that any disorder manifested by fatigue present at any time since the Veteran’s active service is related to the Veteran’s military service. If the examiner determines that the symptoms experienced by the Veteran at any time since his June 1993 separation from active service are not associated with a known clinical diagnosis, then the examiner must indicate whether the Veteran has an undiagnosed illness of which symptoms of fatigue are a manifestation. If the symptoms are not associated with a known clinical diagnosis and also are not deemed manifestations of an undiagnosed illness, then provide an opinion as to whether the Veteran’s signs and symptoms are manifestations of a medically unexplained chronic multi symptom illness. The examiner must consider all relevant evidence of record in rendering any opinion, and the supporting rationale for all opinions expressed must be provided. If the examiner is unable to provide any required opinion, he or she should explain why the required opinion cannot be provided. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any obstructive sleep apnea present during the pendency of this claim. The examiner should opine whether it is at least as likely as not related to an in-service injury, or disease, including the Veteran’s reported symptoms in-service and since. The examiner must consider all relevant evidence of record in rendering any opinion, and the supporting rationale for all opinions expressed must be provided. If the examiner is unable to provide any required opinion, he or she should explain why the required opinion cannot be provided. 4. Obtain an opinion from an appropriate clinician to determine the etiology of any sarcoidosis present during the pendency of the Veteran’s claim. The examiner should opine whether it is at least as likely as not related to an in-service injury, or disease, including the Veteran’s reported history of symptoms. The examiner must consider all relevant evidence of record in rendering any opinion, and the supporting rationale for all opinions expressed must be provided. If the examiner is unable to provide any required opinion, he or she should explain why the required opinion cannot be provided. 4. After completing the above actions, to include any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claims should be readjudicated based on the entirety of the evidence. If any claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. M. E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Adamson, Counsel