Citation Nr: 18152636 Decision Date: 11/23/18 Archive Date: 11/23/18 DOCKET NO. 16-03 996 DATE: November 23, 2018 REMANDED Entitlement to service connection for sleep apnea secondary to service connected migraine headaches is remanded. Entitlement to service connection for trichotillomania secondary to service connected adjustment disorder with mixed anxiety and depressed mood is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1999 to June 2012. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision by the Los Angeles Regional Office (RO) of the Department of Veterans Affairs (VA). In the July 2015 DRO Election Process letter, the Veteran withdrew his appeal for entitlement to service connection for PTSD secondary to service connected adjustment disorder with mixed anxiety and depressed mood. Accordingly, the Board does not have jurisdiction to review this issue, and it is dismissed. 1. Entitlement to service connection for sleep apnea secondary to service connected migraine headaches is remanded. The Board finds that additional development is needed prior to final adjudication of the issues on appeal. First, the Board finds that outstanding treatment records must be obtained and associated with the record. On the Form 9 submitted in January 2016, the Veteran indicated that he received treatment at the VA for the disabilities on appeal. There are no VA outpatient treatment records associated with the file aside from the VA examinations. The Board will remand to obtain these records, and any others that have not yet been associated with the claim file. Further, the Board finds that examinations are needed in order to address the cause of the Veteran’s claimed disabilities. On the Form 9, the Veteran indicated that he believes that his sleep apnea is tied to his migraines. The Board notes that the Veteran is presently service-connected for migraines, and that the Veteran may be entitled to service connection for sleep apnea on a secondary basis. There is no indication from the record that the Veteran received a VA examination for his sleep apnea. The record indicates the Veteran missed his examinations, however, the Veteran states he did not receive notice of the examinations. See VA 21-2507a. Accordingly, the Board will remand for a medical opinion that addresses secondary service connection. 2. Entitlement to service connection for trichotillomania secondary to service connected adjustment disorder with mixed anxiety and depressed mood is remanded. The record contains an October 2015 VA examination finding that the Veteran’s trichotillomania is resolved. The VA examination did not give an explanation as to the resolution of the trichotillomania, whether the Veteran had trichotillomania during the period of appeal, and if the Veteran’s trichotillomania, or any other acquired psychiatric disorder was secondary to his service connected adjustment disorder with mixed anxiety and depressed mood. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Therefore, the Board determines a remand is needed. The matters are REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, as well as service treatment records pertaining to the issues on appeal. 2. Upon completion of the above, schedule the Veteran for an appropriate VA examination to clarify the diagnosis of his sleep apnea disability and to address the cause of any diagnosed disabilities. All appropriate tests and studies should be conducted. The examiner is asked to identify all diagnosed sleep disorders during the appeal period. For each diagnosed disability, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it was related to or caused by the Veteran’s active duty service or, if preexisting service, was aggravated therein. The examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the claimed sleep apnea disability is proximately due to, or the result of, or aggravated (permanently worsened) beyond normal progression by the Veteran’s service-connected migraine disability or service-connected psychiatric disorder. All necessary development should be taken. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. 3. After the development in (1) above has been completed, schedule the Veteran for a VA examination to clarify the nature and cause of his trichotillomania and to address the cause of any currently diagnosed psychiatric disabilities aside from the service connected adjustment disorder with anxiety and depressed mood. All appropriate tests and studies should be conducted. The examiner is asked to identify all diagnosed psychiatric disabilities during the appeal period. The examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that any diagnosed disability was caused by the Veteran’s active duty service or was aggravated therein. The examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the claimed trichotillomania disability is proximately due to, the result of, or aggravated (permanently worsened) beyond normal progression by the Veteran’s service-connected adjustment disorder with mixed anxiety and depressed mood. All necessary development should be taken. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. 4. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Javed, Associate Counsel