Citation Nr: 18142508 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 15-25 491 DATE: October 16, 2018 REMANDED Entitlement to service connection for a low back disorder is remanded. Entitlement to service connection for a neck disorder is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for diabetes mellitus, type II is remanded. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran had active duty military service from June 1979 to October 1999. Entitlement to service connection for a low back disorder Entitlement to service connection for a neck disorder The record shows that the Veteran sustained a series of injuries impacting his neck and low back during his active duty service, including a motor vehicle accident and multiple sports-related injuries. At the VA examination in January 2013, the examiner offered the opinion that the Veteran had a lumbar strain and a cervical sprain, both of which resulted in pain on movement but no other functional impairment. The examiner stated that there was “inadequate documentation” to related either disability to any of the incidents in service and no documentation of any chronicity or ongoing disability since service. The Board finds this opinion to be inadequate in that it does not include any discussion of the Veteran’s history of symptoms of neck or low back pain nor address the question of the impact of any intervening injuries. A new examination and opinion is necessary on remand. Entitlement to service connection for sleep apnea The Veteran has been shown to have a diagnosis of sleep apnea for which a CPAP machine has been provided. He has asserted that his sleep apnea was caused or has been aggravated by his diabetes mellitus, for which a claim of service connection is pending. As a result, this claim is inextricably intertwined with the claim for diabetes mellitus and must be placed in abeyance until the other claim is resolved. Entitlement to service connection for diabetes mellitus, type II The Veteran seeks service connection for diabetes mellitus, type II, which the record indicates was first diagnosed in March 2006, approximately seven years after he separated from active service. He asserts that he had symptoms in service which indicated that diabetes was present, but the disability went undiagnosed because he did not have the classic signs of obesity and high blood pressure. He has stated that the symptome he exhibited on the date of the diagnosis were the same as those experienced in service. The Veteran has not been afforded a VA examination or opinion on this matter. Since the low threshold for a VA examination has been met, one should be afforded on remand. Entitlement to service connection for an acquired psychiatric disability, to include PTSD The Veteran seeks service connection for an acquired psychiatric disability, which he has identified as PTSD. He has provided information on several incidents in service which could qualify as stressor events, including the suicide of two airmen in different assignments. He has submitted records from a private evaluation performed in March 2013 that diagnosed 11 different disabilities, including PTSD, autism, and schizophrenia, but provided no clinical analysis or rationale to support the diagnoses. The Veteran was afforded a VA examination in May 2013, which yielded a diagnosis of depressive disorder with occupational and social impairment due to mild or transient symptoms. The examiner opined that the diagnosis was not related to his military service because the Veteran had not sought any treatment for a mental health condition since his separation from service. The Veteran was afforded another VA examination in July 2017, which found that the Veteran had no diagnosed mental disorder, although he did report symptoms of sleep disturbance and depressed mood. The Board finds that neither of the VA examinations is adequate for adjudicative purposes. The May 2013 VA examination did not consider whether any events in service might have led to the Veteran’s diagnosed depression. The July 2017 VA examination did not account for the prior diagnoses, including the May 2013 diagnosis of depression and the March 2013 private diagnoses of 11 separate disabilities. A new VA examination which considers these deficiencies should be provided on remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any low back or neck disabilities, to include sprains, strains, arthritis, and intervertebral disc syndrome (IVDS). The examiner must offer an opinion as to whether it is at least as likely as not (probability 50 percent or greater) related to any in-service injury, event, or disease, including the sports injuries and the motor vehicle accident in service. The examiner should also address the impact and significance, if any, of any intervening injuries to the Veteran’s neck or low back, to include in 2003 when he was kicked by a student during a scuffle. The examiner should provide a statement of the reasons or rationale for any opinions offered. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s diabetes mellitus, type II. The examiner must offer an opinion as to whether it is at least as likely as not (probability 50 percent or greater) that the Veteran’s diabetes had its onset in service but went unnoticed based on his medical history and body type. The examiner should specifically address the significance, if any, of the Veteran’s reported symptoms of excessive thirst, frequent urination, and blurry vision in service. The examiner should also address the Veteran’s reported incidents of elevated blood glucose levels in service. The examiner should provide a statement of the reasons or rationale for any opinions offered. 3. Schedule the Veteran for a psychiatric examination to determine the nature and etiology of any acquired psychiatric disability, to include depression and PTSD. The examiner should specifically address whether any diagnosed psychiatric disability is at least as likely as not (probability 50 percent or greater) the result of any event or experience in service. The examiner should specifically address the prior diagnoses of record, including depression, autism, schizophrenia, and others, and should provide any evidence which supports such diagnoses and any which is against the diagnoses. The Veteran should specifically be questioned regarding the symptoms endorsed at the time of the March 2013 private evaluation to ensure that no symptoms are overlooked. The examiner should provide a statement of the reasons or rationale for any opinions offered. The examiner should also include a statement regarding the events described in service as each pertains to the ultimate diagnosis rendered. 4. In the event that the VA psychiatric examination yields a diagnosis of PTSD, then appropriate development should be undertaken with respect to the Veteran’s identified stressor incidents, including verification of suicides occurring at the times and locations identified by the Veteran. If, after all due diligence, it is determined that any of the records are unavailable or further efforts to obtain them would be futile, the Veteran and his representative should be so advised in accordance with the provisions of 38 C.F.R. § 3.159(e). 5. Finally, after the above development has been concluded with respect to the Veteran’s claims of service connection for neck and back disabilities, diabetes, and acquired psychiatric disability, IF any of these disabilities is found to warrant service connection, the claim of service connection for sleep apnea should again be considered. Specifically, an examination or opinion should be obtained to determine if sleep apnea was at least as likely as not (probability 50 percent or greater) caused or aggravated by any service-connected disabilities. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Cheryl E. Handy, Counsel