Citation Nr: 18143352 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 16-01 553 DATE: October 18, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to an increased rating for residuals of a transverse fracture with angulation of the distal ends of the right radius and ulna with traumatic arthritis is remanded. REASONS FOR REMAND 1. Entitlement to service connection for sleep apnea is remanded. The Veteran seeks service connection for obstructive sleep apnea. While he was not diagnosed with this disability until approximately 2008, he has submitted competent evidence that he snored for many years prior to that date, including during active duty service. The Court of Appeals for Veterans Claims has stated that VA’s duty to assist a claimant requires, in part, only that the evidence indicates that there may be a nexus between the current disability or symptoms and the Veteran’s service. The types of evidence that indicate that a current disability may be associated with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon v. Nicholson, 20 Vet. App. 79 (2006). In light of the evidence of record, the Board finds a medical opinion is necessary in the present case. 2. Entitlement to service connection for hypertension is remanded. The Veteran seeks service connection for hypertension, which he asserts had its onset in service. A current diagnosis of hypertension is of record. While the Veteran was not diagnosed with hypertension in service, he was placed on blood pressure monitoring on at least one occasion, in March 1996, and his blood pressure was noted to be 160/80 on VA examination in January 1999, within a year of service separation. Thus, a medical opinion is necessary to determine if the Veteran’s current hypertension had its onset in service or within a year thereafter. 3. Entitlement to an increased rating for residuals of a transverse fracture with angulation of the distal ends of the right radius and ulna with traumatic arthritis is remanded. The Veteran seeks an increased rating for his residuals of a transverse fracture of the right radius and ulna. Remand of this issue is required to afford the Veteran a new VA examination to assess the functional impairment resulting from this disability. Specifically, the prior examinations are insufficient for determining the proper disability rating for the Veteran’s service-connected orthopedic disability based on the recent holding of the U.S. Court of Appeals for Veterans Claims (Court) in Correia v. McDonald, 28 Vet. App. 158 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). Such an examination must, among other findings, determine range of motion on both active and passive motion, with and without weight-bearing. Accordingly, remand of this issue is warranted so that a new examination may be conducted and appropriate findings obtained. The matter is REMANDED for the following action: 1. Schedule the Veteran for an appropriate examination by a physician or similar expert in sleep disorders to determine the nature and etiology of any current obstructive sleep apnea. The claims folder must be made available to and reviewed by the examiner in connection with the examination, and a complete history should be elicited from the Veteran. The examiner is also reminded that the Veteran is competent report such observable symptomatology as snoring and daytime somnolence. Upon review of the file, the examiner is asked to specifically address whether it is as likely as not (a 50 percent or greater probability) that the Veteran’s obstructive sleep apnea had its onset during service. The examiner is asked to provide a rationale for his/her opinion. 2. Schedule the Veteran for a cardiovascular examination by a physician or similar expert in cardiovascular disorders to determine the nature and etiology of any current hypertension. The claims folder must be made available to and reviewed by the examiner in connection with the examination, and a complete history should be elicited from the Veteran. The examiner must review the service treatment records, to include the Veteran’s in-service monitoring for elevated blood pressure as well as his blood pressure readings immediately following service. Upon review of the file, the examiner is asked to specifically address whether it is as likely as not (a 50 percent or greater probability) that the Veteran’s hypertension had its onset during service or manifested within a year thereafter. The examiner is asked to provide a rationale for his/her opinion. 3. Schedule the Veteran for an appropriate VA examination so as to determine the current nature and extent of all impairment due to his service-connected right wrist and forearm disability. The record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. The examiner must test and record the range of motion for the wrist and forearm in active motion, passive motion, weight-bearing, and nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, and the degree at which pain begins. The extent of any weakened movement, excess fatigability, and incoordination on use should also be described by the examiner. The examiner should assess the additional functional impairment due to weakened movement, excess fatigability, or incoordination in terms of the degree of additional range of motion loss. The examiner is reminded that he/she should specify the degree of additional functional loss/motion due to pain, to include during flare-ups, or state why it was not feasible to provide such information, as required for an adequate examination. To the extent possible, the examiner is asked to provide retrospective commentary on the Veteran’s impairment level of the right wrist and forearm disability during the appeal period, to include the prior VA examinations performed in conjunction with this claim, and to comment on the range of motion movements that would be painful on passive use, in weight-bearing and non-weight-bearing. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Thomas D. Jones, Counsel