Citation Nr: 18148379 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 16-27 095 DATE: November 8, 2018 REMANDED Entitlement to service connection for a respiratory disorder, to include bronchitis, is remanded. Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1984 to April 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2017, the Veteran testified at a hearing before the undersigned Veterans Law Judge; a transcript of this testimony is of record. In November 2012 a VA respiratory conditions Compensation and Pension examination of the Veteran was conducted. The diagnosis section, Section I, of the examination report asks the question “does the Veteran now have or has he / she ever been diagnosed with a respiratory condition? (This is the condition the Veteran is claiming or for which an exam has been requested).” The examination report indicates “no” but then recounts diagnoses of bronchitis during service. Other evidence of record indicates that the has diagnoses of various respiratory disorders including: bronchitis, chronic obstructive pulmonary disease (COPD), and sleep apnea. The examination report is unclear as to present diagnosis and additional examination with consideration of a recent private medical opinion submitted in May 2017 is necessary. The Board notes that the May 2017 private medical opinion is not sufficient evidence to grant the claim at this time. The opinion suggests the “major cause” of the Veteran’s COPD and sleep apnea is daily inhalation of chemicals. However, the opinion does not differentiate between any such exposure during and after service and recognizes that post-service employment also had an effect on the Veteran’s pulmonary/respiratory problems. Notably, a buddy statement from July 2016 indicates the Veteran had exposure to chemicals in a civilian position for at least six years after his four-year Naval service. No VA Compensation and Pension examination of the Veteran has been conducted with respect to the claim for service connection for bilateral carpal tunnel syndrome. A private medical statement submitted in May 2017 raises the duty to assist requirement to provide an examination. The Board notes that the May 2017 opinion is not sufficient evidence to grant the claim at this time as the physician’s actual opinion as to the etiology of the current disability is unclear to the Board. The physician essentially states that activities in the Navy were “the beginning of the damage to his Carpal Tunnel” and that other (post-service) careers had some bearing on the Veteran’s Carpal Tunnel. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to his claims for service connection. Specifically, request that he provide the information related to his initial diagnoses of carpal tunnel syndrome, COPD and sleep apnea. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the Veteran should be afforded a VA examination to determine the nature of any current respiratory disability, to include bronchitis, COPD, and/or sleep apnea, and to obtain an opinion as to whether any such disability is related to service. The claim file should be reviewed by the examiner. All necessary tests should be conducted and the results reported. The examiner should elicit a full history from the Veteran and consider the lay statements of record. It is noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current respiratory disability is related to an in-service injury, event, or disease, to include exposure to chemicals. The examiner should comment on the May 2017 private medical opinion. A rationale for all opinions expressed should be provided as the Board is precluded from making any medical findings. 3. After records development, the Veteran should also be afforded a VA examination to determine the nature of any bilateral carpal tunnel disability, and to obtain an opinion as to whether such is related to service. The claim file should be reviewed by the examiner. All necessary tests should be conducted and the results reported. The examiner should elicit a full history from the Veteran, including a report of his post-service employment, and consider the lay statements of record. It is noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. Following review of the claims file and examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current carpal tunnel syndrome is related to an in-service injury, event, or disease. The examiner should comment on the May 2017 private medical opinion. (Continued on the next page) A rationale for all opinions expressed should be provided as the Board is precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Havelka, Counsel