Citation Nr: 18147602 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 16-24 407 DATE: November 5, 2018 REMANDED Whether new and material evidence has been received to reopen the claim of entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for an upper-gastrointestinal (GI) disorder, to include gastroesophageal reflux disease (GERD) and gastritis is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for residuals of an excised cyst on the left ear is remanded. Entitlement to service connection for a skin disorder of the hands and feet is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for allergies is remanded. Entitlement to service connection for asthma is remanded. Entitlement to service connection for a low back (thoracolumbar spine) disorder is remanded. Entitlement to service connection for a bilateral or unilateral foot disorder is remanded. Entitlement to service connection for a left hip disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to a disability rating in excess of 30 percent for the service-connected psychiatric disability is remanded. Entitlement to a disability rating in excess of 0 percent for the service-connected left knee disability is remanded. Entitlement to a disability rating in excess of 0 percent for the service-connected left knee scars is remanded. Entitlement to a disability rating in excess of 0 percent for the service-connected pseudofolliculitis barbae is remanded. Entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. REASONS FOR REMAND The appellant is a veteran (the Veteran) who had active duty service from June 1976 to June 1980. This appeal comes before the Board of Veterans’ Appeals (Board) from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, and a May 2015 rating decision of the RO in Nashville, Tennessee. The issue of TDIU entitlement was not separately appealed but is being considered here as a component of the increased rating claims in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009) (where there is evidence of unemployability raised by the record during a rating appeal period, the TDIU is an element of an initial rating or increased rating). The Veteran has reported that he is receiving Social Security Disability (Record 8/30/2017 at 55). However, only a single psychological evaluation from the North Carolina Department of Human Service has been submitted. It is unclear from the record what disabilities are being compensated by the Social Security Administration (SSA). A copy of the SSA decision and its supporting documents has not been submitted. This information is directly pertinent to the issue of TDIU entitlement, and may also be pertinent to the other rating claims and service connection claims. When VA has actual notice of the existence of relevant SSA records, the duty to assist includes requesting those records from the SSA. See Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010) (finding that VA must seek to obtain relevant records under 38 U.S.C. § 5103A when “there exists a reasonable possibility that the records could help the veteran substantiate his claim for benefits”); see also Murincsak v. Derwinski, 2 Vet. App. 363, 370 (1992) (finding VA’s duty to assist specifically includes requesting information from other Federal departments). This duty extends to obtaining a copy of the SSA decision awarding or denying benefits. Id. at 371; Baker v. West, 11 Vet. App. 163, 169 (1998); Hayes v. Brown, 9 Vet. App. 67, 73-74 (1996). While the decision by SSA on the claim for SSA benefits is not controlling with respect to VA’s determination on a claim, see Collier v. Derwinski, 1 Vet. App. 413, 417 (1991), SSA’s determination regarding the veteran’s unemployability and the reasons for that determination are pertinent for VA purposes. See Masors v. Derwinski, 2 Vet. App. 181, 187-188 (1992). The duty to assist a claimant in obtaining records held by SSA is not limited to issues involving unemployability status or severity of service-connected disorders, but extends to claims for service connection. See Quartuccio v. Principi, 16 Vet. App. 183 (2002). In addition, the Board finds that additional evidentiary development is necessary regarding the claim of entitlement to service connection for sleep apnea. The Veteran is claiming that his sleep apnea is secondary to his service-connected PTSD. However, VA has not obtained a medical opinion addressing secondary causation or aggravation of sleep apnea by PTSD. While the Veteran has submitted a private DBQ and opinion, which endorses a relationship between PTSD and sleep apnea, the opinion is apparently based on studies showing that psychiatric disorders are “commonly associated” with sleep apnea, and that there is a higher prevalence of sleep apnea among those with PTSD. However, it is not clear from the studies cited whether the asserted relationship is causal or merely coincidental. Accordingly, the Board finds that a medical opinion is necessary to resolve the appeal of that issue. The matters are REMANDED for the following action: 1. Obtain records relating to the grant of benefits from the SSA, to include the decision granting benefits and any supporting medical records. 2. Schedule an appropriate VA examination to determine the nature and etiology of the Veteran’s sleep apnea. The relevant documents in the claims file should be made available to the VA examiner. Any testing deemed appropriate to provide the opinion should be conducted. 3. The VA examiner is requested to offer an opinion as to whether it is at least as likely as not (i.e., to at least a 50-50 degree of probability) that the claimed sleep apnea (1) is causally or etiologically related to the Veteran’s active service; or, (2) is causally or etiologically related to the service-connected PTSD; or (3) was permanently worsened beyond natural progress by the service-connected PTSD. Note: The term “at least as likely as not” does not mean merely within the realm of medical possibility, but that the medical evidence for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation or permanent worsening as it is to find against causation or permanent worsening. All opinions are to be accompanied by a rationale that is consistent with the evidence of record. A discussion of the pertinent evidence, to include the Veteran’s statements, any relevant medical treatises, and generally accepted medical principles, is requested. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. Readjudicate the remanded claims. If any benefit sought on appeal is not granted, the Veteran and his representative should be provided a supplemental statement of the case and an appropriate time period for response. The case should then be returned to the Board for further consideration, if otherwise in order. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Cramp