Citation Nr: 18144606 Decision Date: 10/25/18 Archive Date: 10/24/18 DOCKET NO. 16-20 748 DATE: October 25, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. Entitlement to service connection for a bilateral foot condition, to include plantar fasciitis, is remanded. Entitlement to service connection for bilateral carpal tunnel is remanded. REASONS FOR REMAND The Veteran served in the California Army National Guard, with active service from February 1996 to June 1996, January 2003 to November 2003, February 2008 to June 2008, and July 2012 to June 2013. Not all the Veteran’s time in the National Guard or Army Reserve qualifies as active service. Active service includes active duty, any period of active duty training (ACDUTRA) during which the individual concerned was disabled from a disease or injury incurred in the line of duty, and any period of inactive duty training (INACDUTRA) during which the individual concerned was disabled from an injury incurred in the line of duty. 38 U.S.C. § 101(21), (24); 38 C.F.R. § 3.6(a). Accordingly, service connection may be granted for disability resulting from disease or injury incurred in, or aggravated, while performing ACDUTRA or from injury incurred or aggravated while performing INACDUTRA. For claims based on aggravation of a pre-existing condition during a period of ACDUTRA or INACDUTRA, the appellant must show that the condition worsened beyond its natural progression during the period of training and that the worsening was caused by the training. See Smith v. Shinseki, 24 Vet. App. 40, 48 (2010). 1. Entitlement to service connection for obstructive sleep apnea is remanded The Veteran has a current diagnosis of sleep apnea, meeting criteria for Shedden element (1). In her substantive appeal, the Veteran asserted that her OSA began during her deployment in 1996, and that she sought medical treatment during that time. There is only a single record (Line of Duty Determination) from 1996, which pertains to the Veteran being injured in a motor vehicle accident during her active duty. No other medical treatment notes from that time are of record. A remand is necessary to obtain records. 2. Entitlement to service connection for a bilateral foot condition, to include plantar fasciitis, is remanded. The Veteran contends that she has bilateral plantar fasciitis as a result of service. Service treatment records document that the Veteran underwent pre-service bunion surgeries in 1986 and 1989 as well as foot surgery in 1997, which was between periods of service. Plantar fasciitis was diagnosed following her separation. While the Veteran reported issues with her feet during service, the record does not show complaints to sick call or other notes concerning foot issues during service. A statement from the Veteran’s former First Sergeant indicates that she did report to sick call for foot issues. As such, it is necessary to obtain additional records in order to fully adjudicate this claim. Additionally, an examination is necessary to determine the etiology of the Veteran’s foot issues, including whether the Veteran’s existing foot conditions were incurred or aggravated in the line of active duty active duty or during periods of ACDUTRA and/or INACDUTRA. Entitlement to service connection for bilateral carpal tunnel syndrome is remanded The Veteran contends that she has carpal tunnel syndrome as a result of service. The Veteran has a diagnosis of carpal tunnel syndrome. The letter from the Veteran’s former First Sergeant indicated that within weeks of her last deployment, the Veteran sought treatment for her hands, and he also stated that he began paperwork to apply for a “line of duty” determination due to the repetitive use of her hands while on duty. There is no other documentation in the record of a request for a line of duty determination for this condition. Accordingly, a remand is necessary to obtain further documentation concerning this asserted claim, and an examination is necessary to determine the etiology of the Veteran’s hand issues, including whether the Veteran’s carpal tunnel syndrome was incurred in the line of active duty active duty or during periods of ACDUTRA and/or INACDUTRA. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and service treatment records regarding the Veteran. Contact the Veteran to determine whether there are any additional relevant private treatment records and obtain any necessary authorizations for such records. 2. Obtain the Veteran’s complete service personnel records, to include all documents pertaining to her service in the Army National Guard. Verify all active duty for training and inactive duty training dates. If necessary, a request should be made to the Defense Finance and Accounting Service (DFAS). Document all requests for information as well as all responses in the claims file. 3. After any records have been associated with the evidentiary record, schedule the Veteran for a VA examinations to determine the nature and etiology of her OSA, bilateral plantar fasciitis, and carpal tunnel syndrome. The claims file and a copy of this remand must be provided to the examiner and he or she must indicate review of these items in the examination report. 4. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. 5. The examiner(s) must provide an opinion and rationale regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s OSA, bilateral plantar fasciitis, and bilateral carpal tunnel syndrome had onset in, or are otherwise related to, active service, to include periods of ACDUTRA/INACDUTRA. 6. If the examiner(s) determine that any of the above conditions pre-existed service, her or she must also provide an opinion and rationale regarding whether it is at least as likely as not that Veteran’s claimed disability was aggravated beyond its natural progression by the Veteran’s active duty or during a period of ACDUTRA/INACTDUTRA and that the worsening was caused by the training. A complete rationale for any opinion expressed must be provided. An examiner’s report that he or she cannot provide an opinion without resort to speculation is inadequate unless the examiner provides a rationale for that statement. As such, if the examiner is unable to offer an opinion, it is essential that the examiner provide a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide the opinion is based on the limits of medical knowledge. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M.E. Lee, Associate Counsel