Citation Nr: 18149891 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 13-04 080 DATE: November 14, 2018 ORDER Service connection for allergic rhinitis is granted. Service connection for sleep apnea is granted. Service connection for gastroesophageal reflux disease is granted. Service connection for an acquired psychiatric disorder is granted. REMANDED Service connection for lumbosacral spine strain and degenerative disc disease is remanded. Service connection for cervical spine degenerative disc disease is remanded. Service connection for diverticulosis remanded. Service connection for endometriosis is remanded. Service connection for radiculopathy of the bilateral lower extremities is remanded. FINDINGS OF FACT 1. The Board notes that the Veteran is a nurse; thus, she is a medical professional competent to report on both her subjective symptoms and their clinical significance. 2. The Veteran has a current diagnosis of chronic allergic rhinitis, which service treatment records show began in service, and the Veteran has provided competent and credible testimony during the June 2018 Board hearing that her symptoms have persisted since service. See March 2017 treatment records, June 2018 private opinion of Dr. B.G., June 2018 Board hearing testimony, and service treatment records (STRs) dated in February 1998, October 1998, March 1999, and May 1999. 3. The Veteran has been diagnosed with sleep apnea. See November 2014 treatment records. She provided competent and credible testimony during the June 2018 Board hearing that that her symptoms began in service and have persisted since service. She testified that she was told by her fellow service member during service that she snored and her ex-husband also told her she snored following service. 4. The Veteran has been diagnosed with gastroesophageal reflux disease (GERD). See September 2012 VAX. The Veteran was frequently prescribed NSAID medications while in service. In a June 2018 letter, the Veteran’s private physician, Dr. G.M., opined that her GERD was as likely as not aggravated by the fact that she took NSAIDs due to her endometriosis while on active duty. 5. The Veteran has diagnoses of depression and posttraumatic stress disorder (PTSD). See January 2018 VA examination. The Veteran provided competent and credible testimony during the June 2018 Board hearing that she was sexually harassed, sexually assaulted, and threatened during service. She further testified that her current symptoms began in service and have persisted since service. CONCLUSIONS OF LAW 1. The criteria for service connection for allergic rhinitis have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 2. The criteria for service connection for sleep apnea have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 3. The criteria for service connection for GERD have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). 4. The criteria for service connection for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1996 to August 1999 and from January 1986 to September 1986. In June 2018, a live videoconference hearing was held before the undersigned; a transcript is of record. To provide the Veteran the broadest and most sympathetic review, the Board has recharacterized the Veteran’s claims of service connection for chronic adjustment disorder, anxiety disorder, and major depressive disorder to encompass any acquired psychiatric disorder as reflected on the title page. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (holding that the Board must consider any disability that “may reasonably be encompassed by” the claimant’s description of the claim, symptoms reported, and other submitted information). REASONS FOR REMAND 1. Service connection for lumbosacral spine strain and degenerative disc disease is remanded. The Veteran submitted a letter from a private physician, Dr. W.C. in June 2018. Dr. W.C. stated the Veteran is currently diagnosed with rheumatoid arthritis and fibromyalgia and it was as likely as not that she had these conditions “all these years.” This opinion is inadequate because it is vaguely worded. A new examination must be obtained to determine whether the Veteran’s reports of back pain are attributable to these diagnoses and whether they are connected to her service. 2. Service connection for cervical spine degenerative disc disease As discussed above, the Veteran has been diagnosed with rheumatoid arthritis and fibromyalgia. A new VA examination must be obtained to determine whether her cervical spine DDD related symptoms may be attributable to fibromyalgia or rheumatoid arthritis. 3. Service connection for diverticulosis is remanded. Treatment records dated in August 2017 note a diagnosis of diverticulitis. October 2017 treatment records note the Veteran was found to have diverticulitis following a colonoscopy in 2015. November 2014 treatment records note that diverticulitis was found after a colonoscopy in 2012 at the Nebraska VA hospital. These records do not appear to have been obtained by the RO. The Veteran was afforded a VA examination in September 2012. The examiner stated that there was no evidence of diverticulosis in the Veteran’s treatment records. Therefore, treatment records documenting the Veteran’s previous colonoscopies must be obtained and a new VA examination must be obtained. 4. Service connection for endometriosis is remanded. The Veteran was afforded a VA examination in October 2015. The examiner opined that the Veteran’s endometriosis was not permanently aggravated beyond its natural progression by service. The examiner described what endometriosis is, but did not provide an actual rationale for the opinion. Therefore, the Board finds this opinion inadequate and a new one must be obtained. 5. Service connection for radiculopathy of the bilateral lower extremities is remanded. As discussed above, the Veteran has been diagnosed with rheumatoid arthritis and fibromyalgia. A new VA examination must be obtained to determine whether her radiculopathy related symptoms may be attributable to fibromyalgia or rheumatoid arthritis. The matters are REMANDED for the following actions: 1. With any needed assistance from the Veteran, obtain any outstanding treatment records, including treatment records documenting a 2012 colonoscopy performed at the Nebraska VA and a 2015 colonoscopy. See treatment records dated in November 2014 and October 2017. 2. After completing step 1, schedule the Veteran for an examination to determine the nature and cause of her diverticulosis. The examiner should answer the following question based on (1) a review of the claims file, (2) interview and examination of the Veteran, and (3) any needed diagnostic testing. a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s diverticulosis began in service or is related to an incident in service? 3. Schedule the Veteran for an examination to determine the nature and cause of her back and neck pain and symptoms of radiculopathy. The examiner should answer the following questions based on (1) a review of the claims file, (2) interview and examination of the Veteran, and (3) any needed diagnostic testing. [The Board draws the examiner and RO’s attention to the June 2018 hearing testimony where the Veteran and her representative outlined pertinent evidence that will hopefully provide helpful information to the examiner and the RO.] a) Are the Veteran’s symptoms and disability pattern (including but not limited to muscle pain and joint pain) consistent with fibromyalgia or rheumatoid arthritis? b) If it is determined that the Veteran’s symptoms are manifestations of either fibromyalgia or rheumatoid arthritis, then please provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the disease or illness had its onset directly during the Veteran’s service, within one year of separation, or is otherwise causally related to any event or circumstance of service. Please consider the June 2018 letter from Dr. W.C. 4. Schedule the Veteran for an examination to determine the nature and cause of her endometriosis. The entire record must be reviewed by the examiner in conjunction with the examination, and all diagnostic tests or studies deemed necessary must be completed. Based on this review and examination of the Veteran, the examiner should provide responses to the following: (a) opine whether there is CLEAR AND UNMISTAKABLE EVIDENCE that her endometriosis BOTH pre-existed service AND was not aggravated (that is, increased in severity BEYOND its natural progression) during service. (b) If the Veteran’s endometriosis is NOT shown to have clearly and unmistakably pre-existed service, please opine whether it is: (i) at least as likely as not (a 50 percent or better probability) that such disability is related to the Veteran’s military service or to a service-connected disability. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. D’Allaird, Associate Counsel