Citation Nr: 18151232 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-48 765 DATE: November 16, 2018 REMANDED Entitlement to service connection for a bilateral foot disorder, to include as secondary to service-connected sarcoidosis, is remanded. Entitlement to service connection for a sleep disorder, to include as secondary to service-connected sarcoidosis, is remanded. REASONS FOR REMAND The Veteran served on active duty for training from June 2009 to November 2009 and on active duty from April 2011 to July 2013. 1. Entitlement to service connection for a bilateral foot disorder, to include as secondary to service-connected sarcoidosis. Remand is required to obtain an adequate VA examination that addresses all theories of recovery. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Additionally, a medical opinion should address the appropriate theories of entitlement and must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). The Veteran alleges that his bilateral foot disorder is related to active service, to include as secondary to service-connected sarcoidosis. See March 2014 Notice of Disagreement. No other arguments were provided. The Veteran’s service treatment records (STRs) show that he was noted to have mild asymptomatic bilateral pes planus upon entry for the active duty period from April 2011 to July 2013. See STRs, Report of Medical Examination, January 6, 2011. The Veteran’s claims file also contains an April 2013 Physical Evaluation Board Proceedings wherein the examiner consistently noted that the Veteran’s bilateral pes planus was asymptomatic and existed prior to service. During a March 2013 General VA examination, the examiner diagnosed bilateral mild pes planus deformity without pronation, asymptomatic, existed prior to active duty service and was not aggravated during active duty. However, the examiner did not provide a supporting explanation for this conclusion and did not address secondary service connection. Additionally, the examiner did not address the Veteran’s in-service diagnosis of plantar fasciitis of the right foot and complaints of right heel pains. See STRs, October 2009. The Veteran’s STRs also noted that he was placed on profile for plantar fasciitis, right, and was restricted from running, marching, jumping, sit-ups, and pushups. Thus, a VA examination is warranted to determine the etiology of this foot disorder. 2. Entitlement to service connection for a sleep disorder, to include as secondary to service-connected sarcoidosis. Remand is required to obtain an adequate VA examination that addresses all theories of recovery. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr, 21 Vet. App. at 311. Additionally, a medical opinion should address the appropriate theories of entitlement and must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl, 21 Vet. App. at 123-24. The Veteran alleges that his sleep disorder is related to active service, to include as secondary to service-connected sarcoidosis. See March 2014 Notice of Disagreement. A May 2016 VA examination was conducted. The examiner noted diagnoses of sleep apnea and narcolepsy with cataplexy. The Veteran reported that he was diagnosed with narcolepsy while he was in the military and that a sleep apnea test was conducted and yielded normal results. The Veteran required the continuous use of medication to control his sleep disorder condition. The examiner opined that the Veteran’s sleep apnea was less likely as not related to the Veteran’s active service or the Veteran’s service-connected sarcoidosis. The examiner reasoned that the Veteran’s AHI results of 3.2 and 4 did not meet the criteria for a diagnosis of obstructive sleep apnea. The examiner further noted that obstructive sleep apnea is a condition related to repetitive collapse of the upper airway, whereas sarcoidosis affects the lower respiratory condition. Therefore, the examiner concluded that the disorders are mutually exclusive and are not related to each other. However, the examination report is inadequate because it failed to address all diagnoses of record, including narcolepsy with cataplexy, and a March 2014 Sleep Study Report from Western Missouri Medical Center which diagnosed obstructive sleep apnea-hypopnea syndrome. A March 2014 private physician note also indicated a possible underlying disorder of hypersomnia. The examination report also failed to address whether the Veteran’s service-connected sarcoidosis aggravated a sleep disorder. For all the foregoing reasons, remand is warranted for a new VA examination. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the nature and etiology of any foot disorder. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must elicit from the Veteran a full history and/or description of his service. (a.) For right foot plantar fasciitis, the examiner must provide an opinion regarding whether it is at least as likely as not (a 50% or greater probability) that the disorder had onset in, or is otherwise related to active duty service from April 2011 to July 2013. (b.) For bilateral pes planus, the examiner must provide an opinion regarding whether it is at least as likely as not (a 50% or greater probability) that the disorder was aggravated by the Veteran’s period of active duty service from April 2011 to July 2013. (c.) For right foot plantar fasciitis and bilateral pes planus, the examiner must opine as to whether the disorder was caused by the Veteran’s service-connected sarcoidosis. (d.) For right foot plantar fasciitis and bilateral pes planus, the examiner must opine as to whether the disorder was aggravated by the Veteran’s service-connected sarcoidosis. (e.) The examiner must address 1) the January 2011 Report of Medical Examination noting mild asymptomatic pes planus; 2) the April 2013 Physical Evaluation Board Proceedings report; and 3) the March 2013 General VA examination report. 4. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of any sleep disorders, to include obstructive sleep apnea. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must elicit from the Veteran a full history and/or description of his active service. (a.) The examiner must provide an opinion regarding whether there are diagnoses of obstructive sleep apnea, narcolepsy, and hypersomnia. A full explanation must be provided, to include with reference to the prior diagnoses of record. (b.) For each diagnosed sleep disorder, the examiner must opine whether the disorder at least as likely as not (50 percent or more probability) had onset in, or is otherwise related to, the Veteran’s active service. (c.) For each diagnosed sleep disorder, the examiner must opine whether the disorder at least as likely as not (50 percent or more probability) was caused by the Veteran’s service-connected sarcoidosis. (d.) For each diagnosed sleep disorder, the examiner must opine whether the disorder at least as likely as not (50 percent or more probability) was aggravated by the Veteran’s service-connected sarcoidosis. The examiner must address: 1) the March 2014 Sleep Study Report from Western Missouri Medical Center which diagnosed obstructive sleep apnea-hypopnea syndrome, and narcolepsy with cataplexy; 2) the March 2014 private physician note indicating a possible underlying disorder of hypersomnia; and 3) the May 2016 VA examination report. 5. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. Nguyen, Associate Counsel