Citation Nr: 18142745 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 16-07 203 DATE: October 17, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a bilateral ankle condition is remanded. REASONS FOR REMAND These matters come to the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision. Although the Board sincerely regrets the additional delay, these matters must be remanded for additional development. Entitlement to service connection for sleep apnea is remanded. The Veteran asserts that he currently suffers from sleep apnea that is related to his active duty service. The medical evidence of record indicates that the Veteran was diagnosed with sleep apnea in April 2016. In addition, the Veteran asserted that he experienced a sleep disorder while he was in the Navy due to his twelve-hour shifts, rotating watches, and the continual noise and disruption from other sailors. In his March 2014 Notice of Disagreement, he again asserted that his sleep apnea developed during service and that he experienced it ever since. In addition, in February 2016, the Veteran’s wife submitted a written statement explaining that the Veteran’s sleep patterns have been “very awkward and abrupt” ever since she met him in 1983. The Veteran’s snoring, she said, is “extraordinarily loud and disruptive” and, as a result, she sleeps in a separate bedroom. VA must provide a medical examination if the evidence indicates the existence of a current disability that may be associated with service, and the record does not contain sufficient medical evidence to decide the claim. 38 U.S.C. § 5103A(d)(2) (2012); 38 C.F.R. § 3.159(c)(4)(i) (2017); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for determining whether the evidence “indicates” that there “may” be a nexus between a current disability and an in-service event, injury, or disease is low. McLendon, 20 Vet. App. at 83. In light of the Veteran’s recent diagnosis and the numerous lay assertions regarding symptoms during and since service, this claim must be remanded for a new VA examination. Entitlement to service connection for a bilateral ankle condition is remanded. As alluded to above, VA has a duty to assist that includes obtaining a medical examination or medical opinion when it is necessary to decide a claim. See 38 U.S.C. § 5103A(d). When VA undertakes to provide an examination or opinion, it must ensure that it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran asserts that he currently suffers from a bilateral ankle condition that had its onset during service. The medical evidence of record indicates that, in February 2016, following an MRI of his right ankle, the Veteran was diagnosed with a chronically ruptured anterior talo-fibular ligament (ATFL), a chronic calcaneofibular ligament partial thickness tear, a suspected tiny medial talar dome osteochondral lesion, mild flexor tenosynovitis, and a sinus tarsi ganglion cyst. Following an MRI of his left ankle, he was diagnosed with a ruptured AFTL characterized as “likely chronic,” a “very thin” calcaneofibular ligament that was possibly related to a prior injury, mild flexor hallucis longus tenosynovitis, and an anterior calcaneal well corticated ossicle likely related to prior trauma with moderate adjacent degenerative change. A VA medical opinion as to the nature and etiology of the Veteran’s ankle condition was obtained in May 2017; however, it failed to discuss the findings of the February 2016 MRIs. Instead, it referred only to the Veteran’s “pain” and concluded that “pain” is a nonspecific symptom which is not pathognomonic (or, characteristic) of the Veteran’s current bilateral ankle condition. As the examiner failed to consider all relevant medical records, the May 2017 opinion is inadequate to decide the claim. See Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). The Board notes that, in his appeal to the Board, the Veteran noted that he planned to obtain a medical opinion regarding his ankle condition and its relationship to service. To date, the claims file contains no such letter. In light of the remand, the Veteran should be provided an additional opportunity to identify relevant evidence. In addition, updated VA treatment records should be obtained and associated with the claims file. See 38 U.S.C. § 5103A(c); 38 C.F.R. § 3.159(c)(2); see also Bell v. Derwinski, 2 Vet. App. 611, 613 (1992) (holding that documents which are generated by VA agents or employees are in constructive possession of VA and, as such, should be obtained and included in the record). These matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from December 2015 to the Present. 2. Ask the Veteran to complete a VA Form 21-4142 for any treatment related to his bilateral ankle condition or his sleep apnea. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his sleep apnea. The examiner must opine whether it at least as likely as not had its onset during service or is otherwise related to service. The examiner is specifically asked to consider the competent lay statements provided by the Veteran and his wife regarding the onset of the Veteran’s sleep apnea. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left or right ankle condition. For each diagnosis identified, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, or if is otherwise related to service. The examiner is specifically asked to consider the Veteran’s competent lay statements about jumping, marching, and twisting his ankles during service. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Freda J. F. Carmack, Associate Counsel