Citation Nr: 18143558 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 15-35 459 DATE: October 19, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected diabetes mellitus (DM) type II, is remanded. REFERRED The issue of entitlement of service connection for a heart disability, to include as secondary to herbicide agents exposure, was raised in the Veteran’s February 2014 Notice of Disagreement (NOD) and is referred to the Agency of Original Jurisdiction (AOJ) for adjudication. REASONS FOR REMAND The Veteran served on active duty from July 1967 to May 1971 in the United States Marine Corps (USMC) and from June 1971 to August 1990 in the United States Air Force (USAF). This case is before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected diabetes mellitus (DM) type II, is remanded. The Veteran seeks service connection for obstructive sleep apnea. He contends that he has experienced symptoms of obstructive sleep apnea including difficulty sleeping and fatigue, as documented in his service treatment records (STRs), continuously since active duty. He further asserts that his sleep apnea is exacerbated by and secondary to his service-connected diabetes mellitus type II. See Notice of Disagreement (NOD), February 2014. While delay is regrettable, the Board finds that further development is necessary to insure proper adjudication of the Veteran’s claim. A review of the Veteran’s treatment records indicate that he required a septorhinoplasty. The diagnosis was acquired nasal deformity and nasal obstruction. See Durham VA Medical Center (VAMC), Surgery Pre-Op Assessment, November 2003. The Veteran reported that he was hit with a pugil stick during basic training in 1967. A history of breathing problems due to facial trauma was noted. See Otolaryngology H&P Note, Durham VAMC, November 2003. In that regard, the Board notes that the Veteran enlisted in the USMC Reserves from April 1967 through July 1967. See First Endorsement on AFPMC Form, August 1971. However, neither military personnel records or service treatment records from April 1967 to July 1967 are associated with the Veteran’s claims file. Further, DD Form 214 reflecting the Veteran’s service prior to June 1971 is also not associated with his file. Accordingly, the nature of the Veteran’s service during that time frame is unclear. VA’s duty to assist requires that these records be obtained or a formal finding of unavailability be issued. The Veteran’s STRs are notable for numerous lung related issues. Records indicate that he was diagnosed with tuberculosis during service requiring treatment for one year. See e.g., Radiographic Report, November 1976. He sustained trauma to his rib cage. See Radiographic Report, May 1973. The Veteran also had numerous sick calls due to sinus and upper respiratory infections, including bronchitis and pneumonia requiring emergency room visits. See e.g., STR, January 1989. VA obtained a medical opinion in August 2015 based upon a records review. The VA examiner opined that it was less likely as not that the current OSA was a continuation of symptoms during active duty. The rationale for that opinion was that there was no evidence specific to OSA during active duty to support causality with current OSA. However, in his NOD the Veteran introduced an additional theory of entitlement in his assertion that his OSA is secondary to his service-connected diabetes mellitus type II. Accordingly, the Board finds that a VA examination to address this contention as well as further assess causation on a direct basis to include as from facial trauma, residuals of tuberculosis or trauma to the Veteran’s rib cage is warranted. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. Obtain the Veteran’s military personnel and service treatment records from the USMC Reserves from April 1967 through May 1971, to include the Veteran’s DD Form 214 for the same time period. All attempts to secure these records should be documented. If attempts to secure the records prove futile, a written memorandum regarding VA’s efforts should be associated with the file, with a copy forwarded to the Veteran. 3. After the above development is completed, schedule the Veteran for an in-person VA examination and obtain a medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran’s obstructive sleep apnea. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished and all clinical findings reported in detail. (a.) Is it at least as likely as not (50 percent or better probability) that the Veteran’s obstructive sleep apnea is related to active duty service? In addressing this question, the examiner should discuss the facial trauma which caused nasal obstruction, if such is documented as having occurred during active duty; the effects, if any, of the Veteran’s diagnosis and treatment of tuberculosis during active duty; and the effect, if any, of trauma due to injury of the Veteran’s rib cage during active duty. The examiner is asked to also evaluate the Veteran’s frequent sick calls due to upper respiratory and nasal infections which caused ongoing breathing difficulties. (b.) Is it at least as likely as not (50 percent or better probability) that the Veteran’s obstructive sleep apnea is caused by his service-connected diabetes mellitus type II? (c.) Is it at least as likely as not (50 percent or better probability) that the Veteran’s obstructive sleep apnea is aggravated by (worsened beyond its natural progression) by his service-connected diabetes mellitus type II? The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Alexander, Associate Counsel