Citation Nr: 18149489 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 16-43 125 DATE: November 9, 2018 REMANDED Entitlement to service connection for left knee disability, to include left knee osteoarthritis, is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1982 to June 1992 and from March 2002 to September 2012. The Veteran has served additional periods of active duty for training and inactive duty for training. 1. Entitlement to service connection for left knee disability is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for left knee disability because no VA examiner has opined whether it is related to service. The Veteran contends he has had knee pain since service and that his current osteoarthritis is due to his years of running, climbing and other activities. The Veteran’s service treatement records reveal a temporary profile for right knee pain. See December 4, 2010 service treatment record. In light of the above, remand is warranted to obtain a VA examination and opinion. 2. Entitlement to service connection for obstructive sleep apnea is remanded. The Veteran was provided a VA sleep apnea examination in June 2015. In October 2015, an addendum was made in order for the examiner to provide a nexus opinion. The examiner stated, “I found no confirmation of sleep apnea in the STRs when veteran was on active duty. Veteran’s OSA is less likely as not incurred in or caused by military service.” The examiner apears to have only considered service treatment records (STRs), and did not consider lay evidence. Although a medical examiner need not address all postive evidence to render an adequate opinion, the examiner’s opinion must still be based on consideration of the relevant medical history, which may be conveyed via lay statements. See Acevedo v. Shinseki, 25 Vet. App. 286, 293 (2012) (“[T]here is no reasons-or-bases requirement imposed on examiners.”); Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007), Buchanan v. Nicholson, 451 F.3d 1331, 1335 (2006). During his March 2015 VA examination, the Veteran reported that prior to his diagnosis his wife noticed he was snoring loudly and sometimes she wasn’t sure if he was breathing while asleep. The Veteran did not specify when his wife noticed these signs. However, in his September 2016 substantive appeal, the Veteran reported that he has had symptoms of sleep apnea in the years prior to his diagnosis, e.g. headaches and being tired, but again did not specify when these symptoms began. In light of the above, remand is warranted for additional examinations and opinions. 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 left knee disability. The claims folder and this remand must be made available to the examiner for review, and the examination report must reflect that such a review was undertaken. The examiner must opine whether it is at least as likely as not related to an in-service injury or disease, including years of jogging, climbing and other activities identified by the Veteran. The examiner must also opine whether it is at least as likely as not left knee osteoarthritis (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. A complete rationale must be provided for any opinion offered. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s obstructive sleep apnea. The claims folder and this remand must be made available to the examiner for review, and the examination report must reflect that such a review was undertaken. The examiner must opine whether it is at least as likely as not related to an in-service injury or disease. A complete rationale must be provided for any opinion offered. 3. After completing any further development deemed necessary, readjudicate the claims. If any benefit on appeal remains denied, issue a supplemental statement of the case (SSOC) to the Veteran and his representative, and allow an appropriate time for response. Thereafter, the case should be returned to the Board, if otherwise in order. MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Gregory T. Shannon, Associate Counsel