Citation Nr: 18149748 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 15-22 649 DATE: November 13, 2018 REMANDED Entitlement to service connection for a sleep disorder, to include as secondary to service-connected right ankle disability is remanded. Entitlement to service connection for bilateral restless leg syndrome, to include as secondary to service-connected right ankle disability is remanded. Entitlement to an initial rating in excess of 20 percent for a right ankle disability is remanded. The Veteran served on active duty in the United States Marine Corps from December 1987 to June 1988. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously remanded in August 2016 for additional development. The Veteran has a 100 percent rating for his depressive disorder and the record does not suggest that he is unable to work as a result of his bilateral ankle and foot disabilities alone. See Rice v. Shinseki, 22 Vet. App. 447 (2009). REASONS FOR REMAND In the Board’s August 2016 remand, it directed the RO to associate any outstanding treatment records, specifically records from Pike Market Medical Clinic in Seattle and Broughton Hospital, between 2005-2007 with the Veteran’s claims file. To date, the RO has not attempted to obtain medical authorizations for these records. 38 C.F.R. § 3.159; Stegall v. West, 11 Vet. App. 268 (1998). In the August 2016 remand, the Board observed that an October 2014 private treatment record found on physical examination no detectable motion through the ankle joint itself, suggesting the appearance of ankylosis of the ankle. The Board also directed the RO to obtain a new examination for the right ankle condition to determine the current level of severity and opine as to whether the Veteran had ankylosis. After the October 2017 VA examination concluding the Veteran did not have ankylosis, the RO did not readjudicate this issue. Thus a remand is necessary. After the April 2014 VA examination, the RO concluded the Veteran does not have a current diagnosis of sleep apnea stating that there are no objective findings consistent with a diagnosis of restless leg syndrome. The RO combined the restless leg syndrome and sleep apnea examinations, ultimately concluding that the Veteran has neither sleep apnea nor restless leg syndrome. This examination and opinion are inadequate because they fail to consider the medical record showing multiple complaints of sleep disturbances and any lay statements regarding sleep problems. Additionally, the Veteran is competent and credible to assert that he has symptoms of tingling in his legs. There is not currently an adequate examination to determine the nature of the Veteran’s restless leg or sleep apnea condition. The Veteran also asserts that his restless leg syndrome and sleep apnea are secondary to his right ankle condition. The examiner must issue an opinion whether these conditions are caused or aggravated by his right ankle. El-Amin v. Shinseki, 26 Vet. App. 136 (2013). The matters are REMANDED for the following action: 1. Obtain any outstanding VA and private treatment records to include private treatment records from Pike Place Market Medical Clinic in Seattle, Washington and from Broughton Hospital between 2005 and 2007. 2. Schedule the Veteran for an examination to determine the nature and etiology of his sleep and restless leg syndrome/bilateral lower extremity disorder. After reviewing the claims file, the examiner should opine whether it is least as likely as not that any identified condition(s): (1) had its onset in service, (2) is related to a disease or injury incurred in service, (3) is caused a service connected disability, and (4) is aggravated by a service connected disability. 3. Issue an SSOC addressing the Veteran’s sleep apnea, restless leg syndrome, and right ankle condition. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate   action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (2012). STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K.Ijitimehin, Associate Counsel