Citation Nr: 18144537 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 15-36 607 DATE: October 24, 2018 REMANDED Entitlement to service connection for sleep apnea, to include as due to asbestos exposure is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) as due to military sexual trauma (MST) is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Air Force from February 1974 to July 1975. These matters come before the Board of Veterans’ Appeals (Board) on appeal from September 2014 and March 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma which denied service connection for sleep apnea, hypertension, and PTSD. The Veteran timely filed a notice of disagreement (NOD) and substantive appeal, via a VA Form 9. In his May 2016 substantive appeal, the Veteran requested a Board hearing by videoconference hearing. In October 2018, the Veteran withdrew his hearing request. In addition, other issues have been withdrawn, as indicated in a September 2018 letter to the Veteran, recognizing his election to participate in the Rapid Appeals Modernization Program (RAMP) with regard to these other issues. 1. Entitlement to service connection for sleep apnea, to include as due to asbestos exposure is remanded. The Veteran contends that his sleep apnea is due to asbestos exposure during service. VA treatment records reflect a July 2014 diagnosis of obstructive sleep apnea syndrome. While the Veteran is service-connected for other respiratory disorders, the Board notes that the Veteran has not been afforded a VA examination in connection with his claim for sleep apnea due to asbestos exposure. In accordance with the duty-to-assist provisions codified at 38 U.S.C. § 5103A (d) and by regulation found at 38 C.F.R. § 3.159 (c)(4), a medical opinion or examination is required if the information and evidence of record does not contain sufficient evidence to decide the claim, but there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the medical evidence of record shows that the Veteran has been noted to have various pulmonary abnormalities, to now include sleep apnea. The Veteran’s service personnel records document that his military occupational specialty (MOS) was a heating system specialist. VA’s Adjudication Manual, which is not binding on the Board, DAV v. Sec’y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017) (“The M21-1 Manual is binding on neither the agency nor tribunals”) but provides guidance on this issue, describes the probability of asbestos exposure by military occupational specialty, which list is not exclusive. M21-1, part IV, subpt. ii, ch. 1, sec. I.3.d. Insulation work is one of the major occupations involving exposure to asbestos. Id. Given the above evidence and in consideration of the Veteran’s indicated MOS, the Board finds that the Veteran was likely exposed to asbestos in service. Thus, the “low threshold” necessary to establish entitlement to a VA medical examination has been satisfied. See 38 U.S.C. § 5103A (d); McLendon, supra; 38 C.F.R. § 3.159 (c)(4); M21-1, part IV, subpt. ii, ch. 1, sec. I.3.f. Accordingly, the claim for service connection for sleep apnea as due to asbestos exposure is remanded for the Veteran to be afforded a VA medical examination that addresses the nature and etiology of his sleep apnea, to include determining the likelihood that his sleep apnea is related to his in-service asbestos exposure. 2. Entitlement to service connection for hypertension is remanded. The Veteran contends that his hypertension had its onset and has continued since service. VA treatment records reflect a diagnosis of hypertension in 2004. A December 2014 Disability Benefits Questionnaire (DBQ) confirmed his diagnosis; however, the examiner did not provide an adequate opinion as to the etiology of his hypertension. When asked about the onset and course of the Veteran’s hypertension, the examiner reported that the Veteran had a diagnosis since 2004 which had to be controlled with medication. The examiner did not address the etiology of the hypertension. Thus, an opinion is warranted to decide the claim. 3. Entitlement to service connection for PTSD is remanded. The Veteran contends that he has a diagnosis of PTSD due to MST and racism. Specifically, the Veteran reported that he was sexually assaulted during basic training and was punished for reporting this. Additionally, he reported that he was bullied because he is black and nothing was done. The Veteran submitted statements from his family and pastor noting his psychiatric symptoms since service. The Veteran is currently service-connected for adjustment disorder with depressed mood associated with tinnitus. His last mental disorder (specified as other than PTSD and eating disorders) DBQ was in August 2015. However, he has not undergone a VA examination to determine whether he has a diagnosis of PTSD or another psychiatric disorder and whether it was due to his MST and/or report of racism. As the Veteran’s statements indicate that he has had persistent and recurring psychiatric symptoms since service, reflecting that these symptoms may be associated with service, a remand for a medical evaluation and nexus opinion is warranted to decide the claim. 38 C.F.R. § 3.159(c)(4)(i)(C) (VA examination warranted where the evidence indicates that a current disability may be associated with another service connected disability). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his obstructive sleep apnea. The claims folder, to include a copy of this remand, must be provided to and reviewed by the examiner in conjunction with the examination. The examiner should indicate whether it is at least as likely as not (at least a 50 percent probability) that his obstructive sleep apnea had its onset in or is otherwise related to the Veteran’s active duty service, to include the Veteran’s conceded in-service asbestos exposure. The examiner should address the Veteran’s written statements and the other evidence of record. All examination findings/results, along with complete, clearly stated rationale for the conclusions reached, must be provided. 2. Obtain an opinion from an appropriate physician as to the etiology of the Veteran’s diagnosed hypertension. The claims folder, to include a copy of this remand, must be provided to and reviewed by the examiner in conjunction with the examination. The physician should indicate whether it is at least as likely as not (at least a 50 percent probability) that his hypertension had its onset in or is otherwise related to the Veteran’s active duty service The examiner should address the Veteran’s written statements and other evidence of record. All examination findings/results, along with complete, clearly stated rationale for the conclusions reached, must be provided. 3. Send to the Veteran the notice related to personal assault PTSD cases and stressor verification under 38 C.F.R. § 3.304 (f)(5). The RO should advise the Veteran of potential secondary sources tending to substantiate his claim of personal assault. 4. Schedule the Veteran for a VA psychiatric examination. The claims folder, to include a copy of this remand, must be provided to and reviewed by the examiner in conjunction with the examination. The examiner should specifically consider all evidence of record related to the Veteran’s alleged in-service MST, to include his assertions, supporting buddy statements, and service treatment records, and determine whether the collective evidence indicates that the alleged assault occurred. If so, the examiner should address whether the Veteran meets, or has met, the diagnostic criteria for PTSD as a result of such stressor. If a diagnosis of PTSD resulting from the identified stressor is deemed appropriate, the examiner should fully explain how the diagnostic criteria are met, to include comment upon the link, if any, between the stressor and the Veteran’s symptoms. The examiner should address the Veteran’s written statements and other evidence of record. All examination findings/results, along with complete, clearly stated rationale for the conclusions reached, must be provided. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Laroche, Associate Counsel