Citation Nr: 18151981 Decision Date: 11/21/18 Archive Date: 11/20/18 DOCKET NO. 16-32 005 DATE: November 21, 2018 REMANDED ISSUES Entitlement to service connection for right elbow disability is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and chronic adjustment disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2006 to April 2007, and from March 2008 to March 2010. The Veteran also has a period of active duty for training (ACDUTRA) from June 1988 to August 1988, and from February 1992 to June 1992. The Board regret further delay, but additional development is necessary before the Board can adjudicate the claim. A. Right Elbow With respect to the Veteran’s claim for service connection for right elbow disability, he underwent a VA examination in August 2015, where the examiner indicated that the Veteran had lateral epicondylitis of the right elbow that has resolved. Radiology report of the right elbow from May 2017 reflects that that the Veteran has increasing small spurs at lateral epicondyle. A medical exam that considers this report is necessary before the Board can adjudicate the claim. B. Sleep Apnea As to the claim of service connection for sleep apnea, the Veteran was given a VA examination in August 2015, where the examiner opined his sleep apnea is less likely than not caused by his military service. The examiner states that “the way the complaints [sleep problems] are written about [in the STR], it seems that they existed during deployment but not after.” However, the Veteran has testified at the April 2017 hearing that his sleep apnea symptoms started in the form of sleep problems since his deployment. See Hearing Transcript at 9. The examiner’s opinion does not adequately address the Veteran’s lay statement. Therefore, a remand is necessary to obtain an adequate opinion. C. Acquired Psychiatric Disorder An August 2015 VA examination found that the Veteran does not have a mental disorder that confirms with DSM-5 criteria. Although the exam shows that the Veteran had stressors in service, the examiner concluded that he currently does not have PTSD symptoms. During the hearing before the undersigned in April 2017, the Veteran testified that he has PTSD symptoms, such as hypervigilance, avoidance of crowds, and panic attacks. See Hearing Transcript at 21. Furthermore, review of the Veteran’s treatment record reflects that he may have chronic adjustment disorder, which was not considered during the August 2015 examination. Therefore, the Board finds that a remand to obtain an adequate examination is necessary. The matters are REMANDED for the following action: 1. Update VA medical treatment records. 2. After completion of directives #1, schedule the Veteran for a VA examination to determine the etiology of claimed right elbow disability. The examiner should review the claims file in its entirety and provide an opinion answering the following questions: Does the Veteran have right elbow disability? If so, is it at least as likely as not (a 50 percent or greater probability) etiologically related to the Veteran’s military service? The examiner is asked to consider and comment on a radiology report of the right elbow from May 2017 that reflects that that the Veteran has increasing small spurs at lateral epicondyle. A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case. 3. After completion of directives #1, schedule the Veteran for a VA examination to determine the etiology of claimed sleep apnea. The examiner should review the claims file in its entirety and provide an opinion answering the following question: Is the Veteran’s sleep apnea at least as likely as not (a 50 percent or greater probability) etiologically related to the Veteran’s active military service? The examiner should consider and comment on the Veteran’s lay statement that he had sleep apnea symptoms in the form of sleep problems since his deployment. A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case. 4. After completion of directive #1, schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of any acquired psychiatric disorder. The examiner should review the claims file in its entirety. Following the completion of the examination, the examiner must provide an opinion answering the following question: Is the Veteran’s acquired psychiatric disorder at least as likely as not (50 percent or greater probability) attributable to service? The examiner is asked to provide an opinion regarding all acquired psychiatric disorder diagnosed.   A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.SOLOMON