Citation Nr: 18151499 Decision Date: 11/20/18 Archive Date: 11/19/18 DOCKET NO. 15-03 504 DATE: November 20, 2018 REMANDED Entitlement to service connection for a right elbow disorder is remanded. Entitlement to service connection for sleep apnea, to include as secondary to service-connected chronic sinusitis and allergic rhinitis, is remanded. Entitlement to service connection for hypothyroidism is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1973 to December 1993. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in July 2018. A transcript is of record. The record was held open for 90 days to allow for the submission of additional evidence. At the hearing, the Veteran’s representative stated her belief that a large portion of the Veteran’s service treatment records were missing from the Veteran’s period of service at McGuire Air Force Base in the mid-1980s. A January 2012 VA memorandum contains that the Veteran’s service treatment records are unavailable; however, in July 2014, the service treatment records were received and associated with the claims file. The Board notes that there are service treatment records from McGuire Air Force Base spanning from 1981 to 1992. Right Elbow Disorder The Veteran has not been afforded a VA examination in connection with his claim for service connection for a right elbow disorder. He testified at the July 2018 hearing that he injured his right elbow on active duty around 1985 and sought treatment at the time. He also stated that he has had problems with his right elbow since that injury. In a September 2018 statement, the Veteran indicated that his right shoulder and right elbow have given him problems since the mid-1980s after falling from an eight-foot ladder while servicing a plane in Africa. The service treatment records do show complaints of pain and a right shoulder muscle strain in August 1987. In addition, a February 2010 treatment record reveals that an MRI report shows multiple osseus loose bodies, possibly synovial chondromatosis, and possibly result of old trauma or arthrosis. Therefore, the Board finds that a VA examination and medical opinion are needed to determine the nature and etiology of any right elbow disorder that may be present. Sleep Apnea The Veteran has not been afforded a VA examination in connection with his claim for service connection for sleep apnea. The Veteran was diagnosed with sleep apnea in December 2012 following a sleep study. His wife testified at the July 2018 hearing that she had to sleep in a different room due to his snoring and that she would elbow him because he would stop breathing. In September 2018, she wrote that she has witnessed her husband’s sleep problems since the mid-1980s. The Veteran also testified at the July 2018 hearing that he experienced sleep disturbances in service and complained of chronic fatigue. He has further claimed that sleep apnea may be caused by his service-connected chronic sinusitis and/or allergic rhinitis. See May 2015 brief. In September 2018, the Veteran wrote that he complained of being extremely tired during the last three to four years of active duty. The Board finds a medical opinion is needed to address both direct and secondary service connection. Hypothyroidism The Veteran has not been afforded a VA examination in connection with his claim for service connection for hypothyroidism. He testified at the July 2018 hearing that he believes he was experiencing chronic fatigue in service due to his undiagnosed hypothyroidism, which was later diagnosed in 1995 by his private physician. The Board finds that a VA examination and medical opinion are needed to determine the nature and etiology of his hypothyroidism. The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for a right elbow disorder, sleep apnea, and hypothyroidism. After acquiring this information and obtaining any necessary authorization, the RO should obtain and associate these records with the claims file. Any outstanding VA medical records should also be obtained and associated with the claims file. 2. The AOJ should ensure that the Veteran’s complete personnel records are associated with the claims file. 3. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any right elbow disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, July 2018 testimony, and assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should identify any current right elbow disorder. If the Veteran does not have a current diagnosis associated with his reported symptoms, the examiner should state this with a fully reasoned explanation. He or she should also address whether there is any functional impairment caused by the Veteran’s reported pain. Evidence of pain alone that causes functional impairment, even without a specific diagnosis or identifiable disease, may constitute a disability for VA purposes. For each disorder identified, the examiner should provide an opinion as to whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to the Veteran’s military service, to include any injury or symptomatology therein. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any sleep apnea that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, July 2018 hearing testimony, and assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should state whether it is at least as likely as not that the Veteran has sleep apnea that manifested in service or is otherwise causally or etiologically related to the Veteran’s military service, to include any symptomatology therein. The examiner should also opine as to whether it is at least as likely as not that the Veteran has a sleep disorder that was either caused by or permanently aggravated by his service-connected chronic sinusitis and/or allergic rhinitis. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion as it is to find against it.) A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 5. After completing the foregoing development, After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any hypothyroidism that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, July 2018 hearing testimony, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has hypothyroidism that manifested in or is otherwise related to his military service, to include any symptomatology therein (such as any fatigue). (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Copies of all pertinent records in the Veteran’s claims file, or, in the alternative, the entire claims file, must be made available to the examiner for review. 6. The AOJ should complete any further development that may be indicated as a result of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Kuczynski