Citation Nr: 18150355 Decision Date: 11/15/18 Archive Date: 11/14/18 DOCKET NO. 15-23 405 DATE: November 15, 2018 REMANDED Entitlement to an initial compensable rating for psoriatic arthritis is remanded. Entitlement to an initial compensable rating for psoriasis is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to a total rating for compensation purposes based on unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2001 to July 2004. This appeal to the Board of Veterans’ Appeals (Board) is from March 2014 and May 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, the Veteran testified before the undersigned Veterans Law Judge during a video conference hearing. The issue of entitlement to a TDIU was raised by the record. Since it is part and parcel to the increased rating claims on appeal, it has been added to the appeal. See Rice v. Shinseki, 22 Vet. App. 447, 453, 54 (2009); see also Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). 1. Entitlement to an initial compensable rating for psoriatic arthritis is remanded. During the October 2018 hearing, the Veteran testified that his disability has worsened since it was last evaluated in April 2014; therefore, he must be scheduled for a VA examination to obtain current findings. 2. Entitlement to an initial compensable rating for psoriasis is remanded. During the October 2018 hearing, the Veteran testified that his disability has worsened since it was last evaluated in March 2014; therefore, he must be scheduled for a VA examination to obtain current findings. Ongoing treatment records should also be added to the record. 3. Entitlement to service connection for sleep apnea is remanded. The Veteran contends his sleep apnea is related to service. After complaints of sleep difficulty and gasping/choking were reported, he had a sleep study in 2010 and was diagnosed with obstructive sleep apnea/hyponea syndrome. Since he attributes this to service, a nexus opinion is needed. 4. Entitlement to a TDIU is remanded. The claim for TDIU is inextricably intertwined with the other issues being remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); Tyrues v. Shinseki, 23 Vet. App. 166, 177-78 (2009) (en banc). Thus, this issue must also be remanded. The matters are REMANDED for the following action: 1. Obtain and associate with the record all ongoing VA treatment records since January 2016. 2. After the additional VA treatment records have been obtained, schedule the Veteran for an appropriate VA examination to determine the severity and manifestations of his psoriatic arthritis. The claims file should be made available to the examiner to review. Any necessary tests or studies should be completed. All complaints, symptoms, and clinical findings should be fully reported. a) The examiner should indicate whether the Veteran’s psoriatic arthritis has been in “active process” at any time since January 2013 and whether it has caused any of the following: anemia, weight loss, severe impairment of health, severely incapacitating episodes, or totally incapacitating episodes with constitutional manifestations. The clinician should also comment on the number of exacerbations a year the Veteran has had based on his medical history and treatment records. b) The examiner should also ascertain the psoriatic arthritis manifestations of the joints involved. The following should be included in the report: • Range of motion testing should be undertaken, to include after repetitive use. The examiner is to report the range of motion measurements in degrees. The examiner should consider whether there is likely to be additional range of motion loss due to any of the following: (1) during flare-ups; (2) after repetitive use over time; (3) in weight bearing and non-weight bearing; and (4) as a result of pain, weakness, fatigability, or incoordination. • The examiner should offer opinions with respect to the additional limitation of motion during flare-ups based on estimates derived from information procured from relevant sources, including the Veteran's lay statements. It is insufficient to conclude that the requested opinion cannot be rendered without resorting to speculation based solely on the fact that the VA examinations were not performed during a flare-up. • The examiner should also address whether there is a difference in active range of motion versus passive range of motion. If so, the examiner is asked to describe the additional loss, in degrees, if possible. In any event, the examiner should fully describe the any associated functional limitations. • The examiner must, at a minimum, ask the Veteran to describe the severity, frequency, duration, and functional loss manifestations related to flare-ups, to include whether there have been any changes since the last examination. c) If the examiner is unable to render the requested opinions without resorting to speculation, he or she must so state. However, a complete explanation for such a finding must be provided, such as whether there is inadequate factual information, whether the question falls within the limits of current medical knowledge or scientific development, whether the cause of the condition in question is truly unknowable, and/or whether the question is so outside the norm of practice that it is impossible for the examiner to use his or her medical expertise and training to render an opinion. 3. After the additional VA treatment records have been obtained, schedule the Veteran for an appropriate VA examination to determine the severity and manifestations of his psoriasis. The claims file should be made available to the examiner to review. Any necessary tests or studies should be completed. All complaints, symptoms, and clinical findings should be fully reported to allow rating the disability under 38 C.F.R. § 4.118, Diagnostic Code 7816. 4. After the additional VA treatment records have been obtained, schedule the Veteran for a VA examination to ascertain if the Veteran’s sleep apnea is related to service. The claims file must be made available to and reviewed by the clinician. Based on the examination and available records, opine whether the Veteran’s sleep apnea is at least as likely as not (50 percent probability or greater) related to his service. A complete rationale supporting the opinion should be included with reference to pertinent evidence as needed. (Continued on the next page)   5. Ensure there has been substantial compliance with the above development prior to readjudicating the claims on appeal, to include entitlement to a TDIU. In doing so, take any corrective action or additional development deemed necessary. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Bredehorst