Citation Nr: 18146273 Decision Date: 10/31/18 Archive Date: 10/30/18 DOCKET NO. 16-35 332 DATE: October 31, 2018 REMANDED Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for sleep apnea, to include as secondary to service-connected disease or injury, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy as an aviation storekeeper from December 1992 to November 2001. 1. Entitlement to Service Connection for Sinusitis is Remanded. 2. Entitlement to Service Connection for Sleep Apnea, to include as Secondary to Service-Connected Disease or Injury, is Remanded. Service treatment records are silent for symptoms, diagnoses or treatment for sinusitis or sleep apnea. In a June 2001 discharge physical examination, the Veteran denied any history of sinusitis and “hay fever” and denied frequent trouble sleeping. The examiner noted no sinus, nose, mouth or throat, or lung abnormalities but did note that the Veteran was 49 pounds overweight. VA treatment records reflect that the Veteran has experienced chronic rhinitis and seasonal allergies since October 2001 and sinusitis since at least January 2011, and was diagnosed with obstructive sleep apnea in June 2013. See January 2011 and June 2013 VA treatment records. The Veteran contends that both disabilities began in service. Regarding chronic sinusitis, the Veteran believes that when he was working on the flight deck of an aircraft carrier, he was exposed to toxins which caused his current sinus issues. He noted exposure to JP-5 aviation fuel, floor wax, and berthing area air filter debris. As to obstructive sleep apnea, the Veteran submitted two buddy statements which state that the Veteran had manifestations of sleep apnea while in service. There is also a service treatment record which reflects that the Veteran sought treatment for trouble breathing at night because of waking up and coughing. See June 2001 service treatment record. The Veteran has also stated that his sleep disorder is caused by his weight, which is due to the inability to lead an active lifestyle because of the chronic pain caused by his service-connected orthopedic disabilities. See June 2014 Notice of Disagreement. The Veteran has not been afforded VA compensation and pension examinations for either condition. A medical examination or medical opinion is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but: (1) contains competent evidence of a current diagnosed disability or persistent or recurrent symptoms of a disability; (2) establishes that an event, injury, or disease occurred in service or certain diseases manifested during an applicable presumptive period for which the claimant qualifies; and (3) indicates that the disability or symptoms may be associated with the established event, injury or disease in service or with another service-connected disability. McClendon v. Nicholson, 20 Vet. App. 79 (2006). Considering the Veteran’s lay statements and buddy statements regarding sleep apnea symptoms during and after service, as well as his contention regarding airborne hazard exposure and chronic sinusitis, the Board finds that the evidence suggests that the current disabilities may be caused or aggravated by service. Therefore, a VA examination and opinion is warranted addressing the potential relationships, if any, between chronic sinusitis and sleep apnea, and the Veteran’s service. While obesity is not a disability per se, obesity may be an “intermediate step” between a service-connected disability and a current disability that may be connected on a secondary basis. In order to meet these criteria, the Veteran must demonstrate affirmative answers to the following inquiry: (1) that a previously service-connected disability caused him to become obese; (2) that obesity was a substantial factor in causing secondary disability; and (3) the secondary disability would only have occurred but for the obesity. VAOPGCPREC 1-2017 (January 6, 2017). The matters are REMANDED for the following action: 1. Request the service personnel records to determine the extent of the Veteran’s duties and potential exposure to airborne hazards as a storekeeper including any duties on an aircraft carrier flight deck. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any sinus disability. The examiner must opine whether a sinus disability is at least as likely as not caused or aggravated by an in-service injury or disease, including alleged exposure to airborne hazards as an aviation storekeeper. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any sleep apnea disability. The examiner must opine: (a.) whether a sleep apnea disability is at least as likely as not caused or aggravated by an in-service injury or disease. (b.) whether a sleep apnea disability is at least as likely as not (1) proximately due to service-connected disability, or (2) aggravated beyond its natural progression by service-connected disability. The examiner must consider the Veteran’s contention that his overweight condition is an intermediate step caused by service-connected orthopedic disabilities as noted above. The examiner is asked to address the July 2013 buddy statements regarding inservice symptomatology, and the June 2001 service treatment record regarding trouble sleeping. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Fitzgerald, Associate Counsel