Citation Nr: 18141606 Decision Date: 10/11/18 Archive Date: 10/10/18 DOCKET NO. 16-20 562 DATE: October 11, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for radiculopathy of the lower left extremity, to include as secondary to service-connected degenerative arthritis of the lumbar spine with lumbago is remanded. Entitlement to service connection for radiculopathy of the right lower extremity, to include as secondary to service-connected degenerative arthritis of the lumbar spine with lumbago is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from September 1983 to July 1986 and from November 1987 to February 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for sleep apnea is remanded. The Veteran seeks service connection for sleep apnea. VA treatment records show a current diagnosis of sleep apnea. A review of the Veteran’s service treatment records shows that the Veteran marked “yes” to “frequent trouble sleeping” and reported that he could only sleep four hours per night on his Report of Medical History at separation in November 2004. The Veteran also has submitted buddy statements from a fellow soldier he served with that generally reported the Veteran had sleep problems in service and described symptoms such as snoring, sounds of obstructed breathing, or lack of breathing. See September 2014 and June 2014 Buddy Statements. The Veteran also submitted statements from his wife who reported that the Veteran experienced snoring and wheezing during his sleep, and that while he was sleeping, the Veteran would sometimes sound as though he were choking or not breathing. The Veteran’s wife reported that the Veteran experienced these symptoms since returning from service. See May 2012, September 2014, and July 2016 Buddy Statements. Based on the foregoing, there is sufficient evidence to find the Veteran’s sleep apnea may be related to active service. Accordingly, a VA opinion is needed. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Entitlement to service-connection for radiculopathy of the lower left and lower right extremities, to include as secondary to service-connected lumbar spine disability is remanded. The Veteran seeks service connection for radiculopathy of his lower left and right extremities, to include as secondary to service connected degenerative arthritis of the lumbar spine with lumbago. The Veteran underwent a VA examination for his claimed bilateral radiculopathy in March 2013. The examiner found insufficient evidence to warrant or confirm a diagnosis of radiculopathy of the right and left lower extremities, and as no condition was diagnosed, he was unable to render an etiological opinion. The Veteran has since submitted a February 2016 treatment record from the Lyster Army Community Hospital (ACH) that shows a diagnosis of lumbago with sciatic and a recent development of radiculopathy based on a complaint of pain radiating into the bilateral thighs. This treatment record also shows a diagnosis of Type 2 diabetes mellitus with diabetic neuropathy, unspecified. The Board notes that diabetes is not a service-connected disorder. Based on the current state of the record, on remand the file should be updated with complete records from the Lyster ACH and the Veteran should be afforded a new VA examination to determine the nature and etiology any lower extremity radiculopathy. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from September 2015 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for the Lyster ACH and any private medical providers who have treated his sleep apnea and/or radiculopathy. Make two requests for the authorized records from Lyster ACH, unless it is clear after the first request that a second request would be futile. 3. Obtain a VA medical opinion regarding the etiology of the Veteran’s sleep apnea from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand. The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s sleep apnea had its onset in, or is otherwise related to, active service. A complete rationale must be provided for all opinions expressed. The rationale must consider the pertinent evidence of record, to include the Veteran’s lay statements, buddy statements, and the Veteran’s report of sleep problems on his November 2004 Report of Medical History. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his claimed lower extremity radiculopathy. The examiner must review the claims file and a copy of this Remand. The examiner should state whether the Veteran has radiculopathy of the right and/or left lower extremity. The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s radiculopathy had its onset in, or is otherwise related to, active service, to include his complaints of extremity pain in August 1992 and leg numbness in October 1999. The examiner also is asked to opine whether it is at least as likely as not that the Veteran’s radiculopathy is caused or aggravated by his service-connected degenerative arthritis of the lumbar spine with lumbago. The term “aggravation” means a chronic worsening of a disability beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should establish a baseline level of severity of the radiculopathy prior to aggravation by the service-connected back disability. If the examiner finds that the Veteran does not have radiculopathy of either the right or left lower extremity, the examiner should specifically state whether the Veteran’s symptoms, to include his complaints of radicular pain, numbness, tingling, and burning, are attributable to a known clinical diagnosis, and if so, whether it is at least as likely as not that the diagnosis is related to service. If any symptoms have not been determined to be associated with a known clinical diagnosis, the examiner should indicate whether the Veteran’s symptoms are manifestations of an undiagnosed illness or part of a medically unexplained multi-symptom illness under 38 C.F.R. § 3.317. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements. Continued on next page-   If the examiner is not able to provide an opinion without resorting to speculation, he or she must provide an explanation for why that is so. The examiner is further advised that the inability to provide an opinion without resorting to speculation must be based on the limitation of knowledge in the medical community at large and not a limitation - whether based on lack of expertise, insufficient information, or unprocured testing - of the individual examiner. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Mortimer, Associate Counsel