Citation Nr: 18148732 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 16-19 637A DATE: November 8, 2018 ORDER Whether new and material evidence exists to reopen the claim for entitlement to service connection for right, upper extremity radiculopathy is granted. Whether new and material evidence exists to reopen the claim for entitlement to service connection for left, upper extremity radiculopathy is granted. Whether new and material evidence exists to reopen the claim for sleep apnea is granted. Whether new and material evidence exists to reopen the claim for entitlement to service connection for sinusitis is granted. Whether new and material evidence exists to reopen the claim for entitlement to service connection for hypertension is granted. Entitlement to service connection for sinusitis is denied. Entitlement to a rating in excess of 30 percent for neck strain disability is denied. Entitlement to a rating in excess of 20 percent from April 2014, and 40 percent from January 2017, for lumbar spine degenerative arthritis disability is denied. REMANDED Entitlement to service connection for right, upper extremity radiculopathy, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for left, upper extremity radiculopathy, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for hypertension, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for angioedema of the throat, to include as secondary to service-connected disabilities and under 38 U.S.C. § 1151, is remanded. Entitlement to service connection for hypothyroidism, to include as secondary to service-connected disabilities and under 38 U.S.C. § 1151, is remanded. Entitlement to service connection for parathyroid adenoma, to include as secondary to service-connected disabilities and under 38 U.S.C. § 1151, is remanded. Entitlement to service connection for seizure disorder, to include as secondary to service-connected disabilities and under 38 U.S.C. § 1151, is remanded. Entitlement to service connection for thyroid cancer, to include as secondary to service-connected disabilities and under 38 U.S.C. § 1151, is remanded. Entitlement to Special Monthly Compensation is remanded. FINDINGS OF FACT 1. In an August 2010 rating decision, the RO denied service connection for bilateral, upper right extremity radiculopathy and sleeping problems. The Veteran was notified of that decision and her appeal rights. She did not appeal the decision. 2. The evidence associated with the claims file since the August 2010 denial does relate to an unestablished fact necessary to substantiate the claim for service connection for bilateral, upper right extremity radiculopathy and sleeping problems; such evidence is not cumulative or redundant of evidence already of record. 3. In a November 2014 rating decision, the RO denied service connection for sinusitis. The Veteran was notified of that decision and her appeal rights. She did not appeal the decision. 4. The evidence associated with the claims file since the November 2014 denial does relate to an unestablished fact necessary to substantiate the claim for service connection for sinusitis; such evidence is not cumulative or redundant of evidence already of record. 5. In December 2011 rating decision, the RO denied service connection for hypertension. The Veteran was notified of that decision and her appeal rights. She did not appeal the decision. 6. The evidence associated with the claims file since the December 2011 denial does relate to an unestablished fact necessary to substantiate the claim for service connection for hypertension; such evidence is not cumulative or redundant of evidence already of record. 7. The preponderance of the evidence is against finding that the Veteran has a sinusitis disability that is etiologically related to a disease, injury, or event which occurred in service. 8. There is no evidence of ankylosis of the cervical spine or lumbar spine for the duration of the appeals period. Prior to January 2017, there is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less. CONCLUSIONS OF LAW 1. The August 2010 rating decision denying service connection for bilateral, upper right extremity radiculopathy and sleeping problems is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.1103 (2017). 2. Evidence received since the August 2010 rating decision is new and material and the claim of entitlement to service connection for bilateral, upper right extremity radiculopathy and sleeping problems is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 3. The November 2014 rating decision denying service connection for sinusitis is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.1103 (2017). 4. Evidence received since the November 2014 rating decision is new and material and the claim of entitlement to service connection for sinusitis is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 5. The December 2011 rating decision denying service connection for hypertension is final. 38 U.S.C. § 7105(c) (2012); 38 C.F.R. §§ 3.156(b), 20.1103 (2017). 6. Evidence received since the December 2011 rating decision is new and material and the claim of entitlement to service connection for hypertension is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017). 7. The criteria for entitlement to service connection for a sinusitis disability have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309, 3.310 (2017). 8. The criteria for an evaluation in excess of 20 percent from April 2014, and 40 percent from January 2017, for lumbar spine degenerative arthritis disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.71a, Diagnostic Codes (DC) 5235 to 5243 (2017). 9. The criteria for an evaluation in excess of 30 percent for the Veteran’s service-connected cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.71a, Diagnostic Codes (DC) 5235 to 5243 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 2003 to November 2005. This matter is before the Board of Veterans’ Appeals (Board) on appeal of June 2016, October 2016, October 2015, June 2014 rating decisions of the Muskogee, Oklahoma, and St. Petersburg, Florida, Regional Offices (RO) of the Department of Veterans Affairs (VA). Duties to Notify and Assist In this case, the Veteran has filed an April 2014 Fully Developed Claim which provided proper notice in regard to the increased rating claims for neck and low back, and service connection claim for sinusitis. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007). The Board also concludes that VA’s duty to assist has been satisfied. The Veteran’s service treatment records and VA medical records are in the Veteran’s claims file. Private medical records identified by the Veteran have been obtained, to the extent possible. The Veteran has not referenced outstanding records that she wanted VA to obtain or that she felt were relevant to the claims. The United States Court of Appeals for Veterans Claims (Court) has also held that VA’s statutory duty to assist the Veteran includes the duty to conduct a thorough and contemporaneous examination so that the evaluation of the claimed disability will be a fully informed one. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991). Where the evidence of record does not reflect the current state of the Veteran’s disability, a VA examination must be conducted. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 3.327(a) (2016). In this case, VA examinations were conducted as described below. The neck and back examinations also addressed functional limitations with regard to employability. The Board finds the examination reports, when considered together, to be thorough and complete and sufficient upon which to base a decision with regard to these claims. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). These examinations, along with the remaining evidence of record, contain sufficient findings to rate the Veteran’s disabilities under the appropriate diagnostic criteria. The Board notes that the January 2017 VA examination regarding the back and neck complies with Correia v. McDonald, 28 Vet. App. 158, 169-170 (2016) (holding that to be adequate a VA examination of the joints must, wherever possible, include joint testing for pain on both active and passive motion, in weight-bearing and non weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint). As there is no indication that any failure on the part of VA to provide additional notice or assistance reasonably affects the outcome of this case, the Board finds that any such failure is harmless. See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev’d on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006). New and Material Evidence 1. Whether new and material evidence exists to reopen the claim for entitlement to service connection for right, upper extremity radiculopathy is granted. 2. Whether new and material evidence exists to reopen the claim for entitlement to service connection for left, upper extremity radiculopathy is granted. 3. Whether new and material evidence exists to reopen the claim for sleeping problems is granted. 4. Whether new and material evidence exists to reopen the claim for entitlement to service connection for sinusitis is granted. 5. Whether new and material evidence exists to reopen the claim for hypertension is granted. Pursuant to 38 U.S.C. § 7104 (b), a decision by the Board may not thereafter be reopened and allowed and a claim based upon the same factual basis may not be considered. As well, a claim that has been denied in a final unappealed rating decision by the RO may not thereafter be reopened and allowed. 38 U.S.C. § 7105(c). The exception to this rule is described under 38 U.S.C. § 5108, which provides that “[i]f new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim.” Therefore, once a rating decision has been issued, absent the submission of new and material evidence, the claim cannot be reopened or adjudicated by VA. 38 U.S.C. §§ 5108, 7104(b); 38 C.F.R. § 3.156, 20.1105; see Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996) (reopening after a prior Board denial). New evidence is defined as existing evidence not previously submitted to agency decision makers. Material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The Board will generally presume the credibility of the evidence in determining whether evidence is new and material. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). Significantly, however, the United States Court of Appeals for the Federal Circuit (Federal Circuit) has held that evidence that is merely cumulative of other evidence in the record cannot be new and material even if that evidence had not been previously presented to the Board. Anglin v. West, 203 F.3d 1343 (2000). In deciding whether new and material evidence has been submitted the Board looks to the evidence submitted since the last final denial of the claim on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is “low.” See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). The August 2010 rating decision denied service connection for tingling of the bilateral, upper extremities and sleeping problems on the basis of no diagnosis. New and material evidence was submitted since that denial, as evidence reflects diagnosis of radiculopathy and sleep apnea. As such, new and material evidence exists to reopen the claim for entitlement to service connection for bilateral, upper extremity radiculopathy and sleeping problems, namely sleep apnea. The November 2014 rating decision denied service connection for sinusitis. New and material evidence was submitted since that denial, as evidence reflects an August 2016 VA examination as to sinusitis. As such, new and material evidence exists to reopen the claim for entitlement to service connection for sinusitis. The December 2011 rating decision denied service connection for hypertension. New and material evidence was submitted since that denial, as evidence reflects VA treatment records documenting hypertension in the context of service-connected disabilities, which the Veteran has stated caused or aggravated the hypertension. As such, new and material evidence exists to reopen the claim for entitlement to service connection for hypertension. Service Connection 6. Entitlement to service connection for sinusitis is denied. Pertinent VA law and regulations provide that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110, 1131 (2012); 38 C.F.R. § 3.303 (2017). Generally, this requires (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); 38 C.F.R. § 3.303(d). Alternatively, service connection may be established either by showing that a chronic disability or disease was incurred during service and later manifestations of such chronic disability or disease are not due to intercurrent cause(s) or that a disorder or disease was incurred during service and there is evidence of continuity of symptomatology which supports a finding of chronicity since service. 38 C.F.R. § 3.303(b). When a chronic disease becomes manifest to a degree of 10 percent within one year of a veteran’s discharge from service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the veteran’s period of service. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2017). The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be more persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b) (2012). Here, the service treatment records (STRs) reflect acute sinusitis diagnosis. The Veteran appeared for a VA examination as to sinusitis in August 2016. The examiner diagnosed chronic sinusitis and allergic rhinitis, diagnosed in 2014 and 2016 respectively. The examiner stated that the sinusitis is less likely than not incurred in or caused by service. The examiner noted that the Veteran was diagnosed with acute, not chronic, sinusitis during service with the last episode in 2004. The examiner elaborated that although there are similar symptoms in service (sinus tenderness), there is a lack of continuity of documented symptoms and/or management of condition over a 10 plus year timeframe. Therefore, the examiner stated that there is a lack of persistent and progressively worsening symptoms during service and/or continuity of symptoms after service. Here, the Board gives the VA examiner’s negative nexus opinion more weight over the Veteran’s lay statements. The Veteran has not been shown to be competent, by experience or training, to provide medical conclusions, especially as to complex medical diagnoses and opinions of etiology. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007) (explaining in footnote 4 that a veteran is competent to provide a diagnosis of a simple condition such as a broken leg, but not competent to provide evidence as to more complex medical questions). The Veteran is similarly not competent without medical expertise to establish that she suffers from chronic sinusitis with onset during service. The evidence of record does not show that a chronic sinusitis condition was incurred in or caused by military service or manifested to a compensable degree within a one-year presumptive period following service. As such, the benefit of the doubt doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001). Therefore, service connection for sinusitis is denied. Increased Rating Legal Criteria for Increased Rating Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155 (2012). Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2017). The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2017). VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. Schafrath, 1 Vet. App. at 589. The degree of impairment resulting from a disability is a factual determination and generally the Board’s primary focus in such cases is upon the current severity of the disability. Francisco v. Brown, 7 Vet. App. 55, 57-58 (1994); Solomon v. Brown, 6 Vet. App. 396, 402 (1994). Staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). 7. Entitlement to a rating in excess of 30 percent for neck strain disability is denied. 8. Entitlement to a rating in excess of 20 percent from April 2014, and 40 percent from January 2017, for lumbar spine degenerative arthritis disability is denied. The Veteran’s cervical spine and lumbar spine disability has been evaluated under the general rating formula for disease and injuries of the spine. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235 to 5243. The Veteran filed an increased rating claim for the neck and low back in April 2014. For the lumbar spine, the Veteran is rated 20 percent from March 2014 and 40 percent from January 2017. For the neck, the Veteran is rated 30 percent from March 2014. The Veteran is separately evaluated for bilateral, lower extremity sciatica secondary to lumbar spine, and radiculopathy for the upper, bilateral extremities is on appeal. The general rating formula (with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease is rated as follows: Unfavorable ankylosis of the entire spine (100 percent); Unfavorable ankylosis of the entire thoracolumbar (50 percent); Unfavorable ankylosis of the entire cervical spine; or forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine (40 percent); Forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine (30 percent); Forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis (20 percent); Forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height (10 percent); Normal forward flexion of the thoracolumbar spine is 0 to 90 degrees, extension is 0 to 30 degrees, left and right lateral flexion are 0 to 30 degrees and left and right lateral rotation are 0 to 30 degrees. The normal combined range of motion for the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5243 (2017). In this case, no objective neurologic abnormalities were found on examination; therefore, no additional rating is warranted under these criteria. Id. Intervertebral disc syndrome (IVDS) is evaluated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation when all disabilities are combined under § 4.25. 38 C.F.R. § 4.71a, Diagnostic Code 5243. Here, there is no evidence of IVDS requiring bed rest, therefore no higher rating is warranted on these criteria. In determining the degree of limitation of motion for musculoskeletal disabilities, the provisions of 38 C.F.R. §§ 4.10, 4.40, and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. The Veteran appeared for a VA examination in January 2017. For lumbar spine, the Veteran reported flare ups occur any time she stays in one position more than 10 minutes. Flare ups last 2-3 minutes and she will fall or have to stand still while leaning on something during that time. She reported she is unable to walk or bend during a flare up. Forward flexion was 20 degrees. Extension was 5 degrees. Right lateral flexion was 15 degrees, left lateral flexion was 10 degrees. Right lateral rotation was 15 degrees, left lateral rotation was 15 degrees. The Veteran had guarding resulting in abnormal gait or abnormal spinal contour. No ankylosis of the spine was found. While IVDS was found, there was no acute episodes requiring bed rest in the past year. In January 2017, for cervical spine, forward flexion was 30 degrees. Extension was 30 degrees. Right lateral flexion was 20 degrees, left lateral flexion was 20 degrees. Right lateral rotation was 40 degrees, left lateral rotation was 40 degrees. There was no ankylosis of the spine. No IVDS was found. No flare-ups were reported. The Veteran appeared for a VA examination in March 2015. For lumbar spine, the Veteran reported flare-ups. Forward flexion was 80 degrees. Extension was 25 degrees. Right lateral flexion was 25 degrees, left lateral flexion was 25 degrees. Right lateral rotation was 30 degrees, left lateral rotation was 30 degrees. There was no ankylosis of the spine. No IVDS was found. In March 2015, for cervical spine, no flare-ups were reported. Forward flexion was 40 degrees. Extension was 40 degrees. Right lateral flexion was 35 degrees, left lateral flexion was 35 degrees. Right lateral rotation was 70 degrees, left lateral rotation was 70 degrees. There was no ankylosis of the spine. No IVDS was found. The Veteran appeared for a VA examination in June 2014. For lumbar spine, the Veteran reported flare-ups as limited walking and standing. Forward flexion was 50 degrees, with painful motion at 45 degrees. Extension was 20 degrees. Right lateral flexion was 25 degrees, left lateral flexion was 25 degrees. Right lateral rotation was 20 degrees, left lateral rotation was 20 degrees. No IVDS was found. The examiner noted the degree of ROM loss during pain on use or flare ups is approximately 10 degrees in flexion. In June 2014, for cervical spine, flare-ups were reported as limited walking and standing. Forward flexion was 30 degrees, with painful motion at 25 degrees. Extension was 30 degrees. Right lateral flexion was 35 degrees, left lateral flexion was 30 degrees. Right lateral rotation was 35 degrees, left lateral rotation was 25 degrees. No IVDS was found. The examiner noted the degree of ROM loss during pain on use or flare ups is approximately 10 degrees in flexion. Upon review of the evidence, entitlement to a rating in excess of 30 percent for neck strain disability is denied, and entitlement to a rating in excess of 20 percent from April 2014 and 40 percent from January 2017 for lumbar spine degenerative arthritis disability is denied. There is no ankylosis noted for the cervical or lumbar spine for the duration of the appeals period. Specifically, there is no evidence of unfavorable ankylosis of the entire spine to warrant a 100 percent rating, or unfavorable ankylosis of the entire thoracolumbar to warrant a 50 percent rating for the lumbar spine. Therefore, from January 2017 to present, no higher rating is warranted for the lumbar spine. Prior to January 2017, there is no evidence of forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. Therefore, a higher rating of 40 percent is not warranted for the lumbar spine prior to January 2017. There is no evidence of ankylosis of the cervical spine, therefore, no higher rating is warranted for unfavorable ankylosis of the entire cervical spine, rated at 40 percent. The Board accepts that the Veteran reports painful motion in the cervical spine and low back and at times during the appeal period has reported flare-ups resulting in limited motion. See DeLuca. The Board also finds the Veteran’s own reports of symptomatology to be credible. However, neither the lay nor medical evidence reflects the functional equivalent of limitation of motion or the functional equivalent of limitation of flexion required to warrant the next higher evaluation pendency of the appeal. As such, the Board finds that the currently assigned evaluation is appropriate for the Veteran’s cervical spine and low back disability. In sum, the Board finds the preponderance of the evidence is against the increased rating claim for a rating for cervical spine and low back disability. Thus, the benefit of the doubt doctrine is not for application. REASONS FOR REMAND 1. Entitlement to service connection for right, upper extremity radiculopathy is remanded. 2. Entitlement to service connection for left, upper extremity radiculopathy is remanded. The Veteran is service connected for neck strain. An October 2011 medical treatment note reflects cervical neurological pain. A December 2012 private treatment note reflected cervical spine radiculopathy by history. A November 2016 private treatment record noted neck pain with radiation to both upper extremities. A May 2017 private report reflects cervical radiculopathy. However, a January 2017 VA examiner noted no radiculopathy regarding the cervical spine. A VA examiner’s opinion is required, to clarify if the Veteran has a present diagnosis of upper right and/or left extremity radiculopathy. 3. Entitlement to service connection for sleep apnea is remanded. By July 2018 Appellate Brief and June 2017 Substantive Appeal, the Veteran stated her sleep apnea may be caused or aggravated by service-connected disabilities. She also stated that her in-service headaches and leg swelling and increased blood pressure may have indicated the presence of apnea. In light of these statements, a VA examiner’s clarifying opinion is requested. 4. Entitlement to service connection for hypertension is remanded. In light of the Veteran’s statements, to include the July 2018 Appellate Brief, a VA examiner’s opinion is required to opine whether the Veteran’s hypertension is related to in-service blood pressure fluctuations, and/or caused or aggravated by service-connected disabilities, to include medication taken for service-connected disabilities. In light of these statements, a VA examiner’s clarifying opinion is requested. 5. Entitlement to service connection for angioedema of the throat is remanded. In light of the Veteran’s statements, to include the July 2018 Appellate Brief, a VA examiner’s opinion is required to opine whether the Veteran’s angioedema is at least as likely as not related to in-service ankle swelling, and/or caused or aggravated by service-connected disabilities, to include medication taken for service-connected disabilities. In light of these statements, a VA examiner’s clarifying opinion is requested. 6. Entitlement to service connection for hypothyroidism is remanded. 7. Entitlement to service connection for parathyroid adenoma is remanded. 8. Entitlement to service connection for seizure disorder is remanded. 9. Entitlement to service connection for thyroid cancer is remanded. The Veteran appeared for a VA examination in regard to thyroid in May 2016. While the examiner opined that the thyroid condition and seizure condition are less likely as not due to her depressive disorder, the opinion did not address aggravation. In light of the Veteran’s statements, to include the July 2018 Appellate Brief, a VA examiner’s opinion is required to opine whether the Veteran’s thyroid related disabilities is at least as likely as not related to service, and/or caused or aggravated by service-connected disabilities, to include medication taken for service-connected disabilities. 10. Entitlement to Special Monthly Compensation is remanded. As the adjudication of this issue is inextricably intertwined with other issues on remand, adjudication of this issue is deferred. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any upper right and left extremity radiculopathy. The examiner must opine whether it 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, specifically cervical spine disability. Please offer a clarifying opinion in light of conflicting evidence of record: An October 2011 medical treatment note reflects cervical neurological pain. A December 2012 private treatment note reflected cervical spine radiculopathy by history. A November 2016 private treatment record noted neck pain with radiation to both upper extremities. A May 2017 private report reflects cervical radiculopathy. A January 2017 VA examiner noted no radiculopathy regarding the cervical spine. 2. Please send the claims file to a VA examiner for an opinion on sleep apnea. An exam should be scheduled if required by the examiner to respond to the questions. The examiner must opine whether the Veteran’s sleep apnea is at least as likely as not related to an in-service injury, event, or disease, including in-service headaches, leg swelling, and blood pressure fluctuations. Please also opine whether sleep apnea is at least as likely as not (1) proximately due to any service-connected disability, or (2) aggravated beyond its natural progression by any service-connected disability, to include medication taken for service-connected disabilities. 3. Please send the claims file to a VA examiner for an opinion on hypertension. An exam should be scheduled if required by the examiner to respond to the questions. The examiner must opine whether the Veteran’s hypertension is at least as likely as not related to an in-service injury, event, or disease, including in-service blood pressure fluctuations. Please also opine whether hypertension is at least as likely as not (1) proximately due to any service-connected disability, or (2) aggravated beyond its natural progression by any service-connected disability, to include medication taken for service-connected disabilities. 4. Please send the claims file to a VA examiner for an opinion on angioedema. An exam should be scheduled if required by the examiner to respond to the questions. The examiner must opine whether the Veteran’s angioedema is at least as likely as not related to an in-service injury, event, or disease, including in-service ankle swelling. Please also opine whether angioedema is at least as likely as not (1) proximately due to any service-connected disability, or (2) aggravated beyond its natural progression by any service-connected disability, to include medication taken for service-connected disabilities. 5. Please send the claims file to a VA examiner for an opinion as to hypothyroidism, parathyroid adenoma, seizure disorder, and thyroid cancer. An exam should be scheduled if required by the examiner to respond to the questions. The examiner must opine whether the Veteran’s hypothyroidism, parathyroid adenoma, seizure disorder, and thyroid cancer is at least as likely as not related to an in-service injury, event, or disease. Please also opine whether hypothyroidism, parathyroid adenoma, seizure disorder, and thyroid cancer is at least as likely as not (1) proximately due to any service-connected disability, or (2) aggravated beyond its natural progression by any service-connected disability, to include medication taken for service-connected disabilities. 6. After the above is complete, readjudicate the Veteran’s claims, to include entitlement to Special Monthly Compensation. If a complete grant of the benefits requested is not granted, issue a supplemental statement of the case (SSOC) to the Veteran and her representative to afford them the opportunity to respond before the case is returned to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. M. Georgiev