Citation Nr: 18150766 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-46 005A DATE: November 15, 2018 ORDER Entitlement to a sleep disability described as poor sleep efficiency is granted. REMANDED Entitlement to a rating in excess of 60 percent for residuals status post excision of bladder carcinoma is remanded. Entitlement to service connection for multiple bladder infections as secondary to service-connected residuals status post excision of bladder carcinoma is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder and anxiety disorder, is remanded. Entitlement to a sleep disability other than poor sleep efficiency, to include obstructive sleep apnea, is remanded. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his poor sleep efficiency disability is caused in part by his service-connected residuals status post excision of bladder carcinoma. CONCLUSION OF LAW The criteria for secondary service connection for poor sleep efficiency disability are met. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1983 to April 1987. 1. Entitlement to a sleep disability described as poor sleep efficiency is granted. An April 2014 sleep study shows a diagnosis of poor sleep efficiency. An August 2014 private physician opined that the Veteran’s poor sleep efficiency is due in part to the Veteran having to wake up frequently to void due to his service-connected bladder problems relating to his bladder cancer residuals. The private physician’s opinion is in accord with other evidence in the Veteran’s claims file. In a May 2013 statement, the Veteran reported that he wakes to void 12 or more times during the night. In October 2015 VA treatment, the Veteran reported that he is not able to sleep more than 3 hours a day due to his constant need to void during the night. In light of the lay and medical evidence of record, and resolving doubt in favor of the Veteran, the Board finds that service connection for poor sleep efficiency as secondary to service-connected residuals status post excision of bladder carcinoma is warranted. REASONS FOR REMAND 1. Entitlement to a rating in excess of 60 percent for residuals status post excision of bladder carcinoma is remanded. 2. Entitlement to service connection for multiple bladder infections as secondary to service-connected residuals status post excision of bladder carcinoma is remanded. 3. Entitlement to service connection for an acquired psychiatric disorder, to include depressive disorder and anxiety disorder, is remanded. 4. Entitlement to a sleep disability other than poor sleep efficiency, to include obstructive sleep apnea, is remanded. The Veteran asserted that his service-connected bladder cancer residuals disability has worsened. A May 2016 document in the Veteran’s claims file shows that a VA examination was to be scheduled to evaluate the current severity of the Veteran’s service-connected disability. The Statement of the Case indicates that the Veteran did not respond to a call to schedule the VA examination. In a June 2016 statement, the Veteran explained that he was out of town when he received a call regarding the VA examination and that he attempted to contact an individual at VA several times before he discovered that his examination was cancelled. Accordingly, remand is appropriate to afford the Veteran an opportunity to appear for a VA examination to address the current nature and severity of the Veteran’s bladder cancer residuals disability. The Veteran seeks service connection for infections of the bladder as secondary to his service-connected bladder cancer residuals disability. A January 2014 VA examiner opined that there was no evidence in the record showing infection. However, a February 2015 VA examiner noted a laboratory finding of asymptomatic microhematuria related to the Veteran’s service-connected bladder cancer residuals disability. The Veteran asserts that the hematuria is evidence of infection. While this matter is on remand, further VA medical opinion should be obtained. The Veteran seeks service connection for an acquired psychiatric disorder, to include depressive disorder and anxiety disorder, secondary to his service-connected bladder cancer residuals disability. In an August 2014 DBQ, a private psychiatrist opined that the Veteran’s anxiety was due to his sleep and bladder problems. However, the private psychiatrist’s opinion is inadequate because a rationale was not provided. A May 2013 VA examiner opined that the Veteran’s depressive disorder is less likely than not caused by his service-connected bladder cancer residuals. The VA examiner explained that the Veteran first sought psychiatric care in 2005, twenty years after his service discharge and the events that led to his service-connected disability. The VA examiner explained that there was no temporal relationship and therefore no connection. The May 2013 VA examiner’s opinion is factually inaccurate as the Veteran received VA treatment for psychiatric issues beginning in 2002. In addition, it appears the VA examiner only considered the Veteran’s bladder cancer in service rather than the current service-connected bladder cancer residuals disability. The Veteran reported that his bladder cancer residuals have worsened in recent years. The VA examiner also did not address whether the Veteran’s psychiatric disability is aggravated by his service-connected bladder cancer residuals disability. Accordingly, remand is appropriate for further VA medical opinion. In addition to his now service-connected poor sleep efficiency, the Veteran has diagnoses of insomnia disorder and obstructive sleep apnea. A February 2015 VA examiner opined that the Veteran’s obstructive sleep apnea is less likely than not related to the Veteran’s service-connected bladder cancer residuals disability. The VA examiner explained that the Veteran was diagnosed with sleep disabilities in 2010 and that there is no evidence that the Veteran’s sleep disabilities are related to any incident during service, such as bladder carcinoma. The VA examiner explained that there was no temporal relationship between the Veteran’s sleep apnea and his 1984 bladder carcinoma. It appears the VA examiner only considered the Veteran’s bladder cancer in service rather than the current service-connected bladder cancer residuals disability. The VA examiner also did not address whether the Veteran’s sleep apnea is aggravated by his service-connected bladder cancer residuals disability. Accordingly, remand is appropriate for further VA medical opinion. The Veteran reported three treatment sessions with his private psychiatrist, Dr. Rodriguez Robles. While this matter is on remand, the Regional Office should coordinate with the Veteran to obtain these records. In addition, it appears relevant VA treatment records are missing from the Veteran’s claims file. The Veteran’s vocational rehabilitation file contains records showing the Veteran received VA treatment for depression in 2002 and 2003. However, it does not appear that these records are in the claims file. Accordingly, remand is appropriate to obtain outstanding VA treatment records, to include any additional VA treatment records from 2002 and 2003 and VA treatment records from August 2016 to the present. The Board notes that while many documents have been translated in the Veteran’s claims file, the Veteran’s vocational rehabilitation file contains some Spanish language documents. While on remand, the AOJ should take the opportunity to review the Veteran’s claims file and translate any untranslated documents, to include the documents in the Veteran’s vocational rehabilitation file. The matters are REMANDED for the following action: 1. After securing any necessary authorization, obtain any private treatment records as the Veteran may identify relevant to his claims, to include treatment records from Dr. Rodriguez Robles. 2. Obtain outstanding VA treatment records, to include any additional VA treatment records from 2002 and 2003 and VA treatment records from August 2016 to the present. 3. Review the claims file, and translate from Spanish into English any untranslated document, to include the documents in the Veteran’s vocational rehabilitation file. 4. After obtaining any outstanding records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected residuals status post excision of bladder carcinoma. The examiner should review the Veteran’s claims file. The examiner should provide a full description of the disability and report all manifestations of the Veteran’s disability, including under the applicable rating criteria. The examiner should opine as to whether the Veteran has had a bladder infection at any time during the appeal period (from November 2012 to the present) and whether it is recurrent or chronic. If so, the examiner should opine as to whether such infection is part of the Veteran’s service-connected residuals status post excision of bladder carcinoma. If such infection is separate from the Veteran’s service-connected residuals status post excision of bladder carcinoma, the examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the disability: (a) had an onset in service; (b) is otherwise related to an in-service injury, event, or disease; or (c) is caused by or aggravated by his service-connected bladder cancer residuals. The examiner should consider all medical and lay evidence of record. The Veteran reported repeated bladder infections, and reported that he has been placed on antibiotics. A complete rationale should be given for all opinions and conclusions expressed. 5. After obtaining any outstanding records, ask the appropriate mental health examiner to review the Veteran’s file. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The examiner should identify any current psychiatric disability the Veteran has presented during the claim period (from October 2012 to the present), including depressive disorder and anxiety disorder. For each diagnosis, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the disorder: (a) had an onset in service; (b) is otherwise related to an in-service injury, event, or disease; (c) is caused by or aggravated by his service-connected bladder cancer residuals; (d) is caused by or aggravated by his service-connected poor sleep efficiency disability; or (e) is caused by or aggravated by a sleep disability other than poor sleep efficiency. The examiner should consider all medical and lay evidence of record. The Veteran asserts that his psychiatric disability is caused by his service-connected bladder cancer residuals. An August 2014 private psychiatrist opined that the Veteran’s anxiety was due to his sleep and bladder problems. A complete rationale should be given for all opinions and conclusions expressed. 6. After obtaining any outstanding records, ask the appropriate examiner to review the Veteran’s file. The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner. The examiner should identify any current sleep disability other than the service-connected poor sleep efficiency the Veteran has presented during the claim period (from October 2013 to the present), including obstructive sleep apnea. For each disability, the examiner should opine whether it is at least as likely as not (a 50 percent or greater probability) that the disorder: (a) had an onset in service; (b) is otherwise related to an in-service injury, event, or disease; or (c) is caused by or aggravated by his service-connected bladder cancer residuals. The examiner should consider all medical and lay evidence of record. The Veteran asserts that his sleep disability is caused by the voiding dysfunction of his service-connected bladder cancer residuals. A complete rationale should be given for all opinions and conclusions expressed. 7. After the above development, and any other development deemed necessary, readjudicate the claims. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Purcell, Associate Counsel