Citation Nr: 18150234 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-42 621 DATE: November 14, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. Entitlement to service connection for migraine headaches is remanded. Entitlement to an initial rating in excess of 10 percent for left lower extremity sciatic nerve radiculopathy is remanded. Entitlement to an initial rating in excess of 10 percent for left lower extremity femoral nerve radiculopathy is remanded. REASONS FOR REMAND The Veteran had active military service from August 1983 to February 2006. This case comes before the Board of Veterans’ Appeals (Board) on appeal from June 2013, October 2014, and June 2015 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) St. Louis, Missouri. The Board finds that additional development is required before the claims on appeal may be decided. Service Connection Sleep Apnea and IBS The Veteran has asserted that his sleep apnea and IBS are related to his period of active service, or in the alternative, were caused or aggravated by a service-connected disability, to include medication take for treatment of such. Of record are multiple private and VA medical opinions relating to the Veteran’s claims of entitlement to service connection for sleep apnea and IBS. However, a review of those medical opinions shows that they are not adequate to decide the claims. In this regard, the Board notes that not only are they conflicting, but they also lack adequate supporting rationale for the conclusions reached. As such, the Board finds that the medical evidence currently of record is insufficient to decide the claims of entitlement to service connection for sleep apnea and IBS. Therefore, the Veteran should be afforded new VA examinations to determine the nature and etiology of his sleep apnea and IBS, to include whether they were caused or aggravated by a service-connected disability. Migraine Headaches The issue of entitlement to service connection for migraine headaches is inextricably intertwined with the claim for entitlement to service connection for a sleep apnea remanded herein, as the evidence raises questions as to whether the claimed disability is secondarily related to the Veteran’s claimed sleep apnea. Harris v. Derwinski, 2 Vet. App. 180, 183 (1991). Hence, a determination on the claim for entitlement to service connection for migraine headaches, should be deferred pending final disposition of the claim for entitlement to service connection for sleep apnea. Increased Rating Claims A VA examination conducted in July 2016 is the most recent examination of record with regard to his lower extremity radiculopathy. In his August 2018 informal hearing presentation, the Veteran’s representative indicated a discernable worsening of the Veteran’s symptoms. Moreover, a review of the record reflects that the Veteran was treated for radiculopathy at various times after July 2016. Therefore, a new VA examination is necessary to determine the current level of severity of all impairment resulting from the Veteran’s service-connected left lower extremity sciatic nerve and femoral nerve radiculopathy. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of his sleep apnea. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that sleep apnea had its onset during active service, or is otherwise etiologically related to such service. The examiner should also provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s sleep apnea was caused or chronically worsened by a service-connected disability. In forming the opinions, the examiner must specifically address the Veteran’s assertion that medication he takes for treatment of service-connected disabilities causes or aggravates his sleep apnea. In forming the opinions, the examiner must also specifically address the Veteran’s assertion that he developed obesity as a result of service-connected disabilities and that his obesity causes or aggravates his sleep apnea. The rationale for all opinions expressed must be provided. 3. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise, who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of his IBS. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that IBS had its onset during active service, or is otherwise etiologically related to such service. The examiner should also provide an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s IBS was caused or chronically worsened by a service-connected disability. In forming the opinions, the examiner must specifically address the Veteran’s assertion that medication he takes for treatment of service-connected disabilities causes or aggravates his IBS. In forming the opinions, the examiner must also specifically address the Veteran’s assertion that he developed obesity as a result of service-connected disabilities and that his obesity causes or aggravates his IBS. The rationale for all opinions expressed must be provided. 4. Schedule the Veteran for a VA examination by an examiner with appropriate expertise to determine the current level of severity of all impairment resulting from his left lower extremity sciatic nerve and femoral nerve radiculopathy. The claims file must be made available to, and reviewed by the examiners. Any indicated studies should be performed. The examiner must provide all information required for rating purposes. 5. Confirm that the VA examination reports and all medical opinions provided comport with this remand, and undertake any other development determined to be warranted, to include obtaining any necessary VA examinations and opinions pertaining to the Veteran’s claim of entitlement to service connection for migraine headaches. 6. Then, readjudicate the issues on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. O’Donnell, Associate Counsel