Citation Nr: 18153004 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 18-06 992 DATE: November 27, 2018 REMANDED Entitlement to service connection for a bilateral lower extremity disability (claimed as peripheral neuropathy and radiculopathy), to include as secondary to a nonservice-connected disability, is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to a nonservice-connected disability, is remanded. Entitlement to service connection for sleep disorder (claimed as obstructive sleep apnea (OSA) and sleep deprivation), to include as secondary to a nonservice-connected disability, is remanded. Entitlement to service connection for erectile dysfunction, to include as secondary to a nonservice-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from September 2000 to May 2004. The Veteran served in the Army National Guard from September 1998 to March 2012. He had periods of active duty for training (ACDUTRA) from March 1999 to September 1999 and from April 2007 to May 2007, as well as additional unverified periods of ACDUTRA. The Board has recharacterized the issues to reflect the Veteran’s contentions and the medical evidence of record. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Other than the September 2000 enlistment examination, the Veteran’s active duty and ACDUTRA service treatment records are missing. The AOJ has been unable to obtain these records despite extensive efforts to locate them. The AOJ made a Formal Finding of Unavailability, and notified the Veteran of such in September 2010. The AOJ has repeatedly requested that the Veteran provide copies of all service medical treatment records. See October 2005, January 2007, August 2007, September 2010, and June 2013 Correspondence. The Veteran has not provided any records nor responses to these requests. When a Veteran’s STRs are unavailable through no fault of his own, VA’s duty to assist is heightened. Milostan v. Brown, 4 Vet. App. 250, 252 (1993). 1. Entitlement to service connection for a bilateral lower extremity disability (claimed as peripheral neuropathy and radiculopathy), to include as secondary to a nonservice-connected disability, is remanded. The Veteran alleges that he has a bilateral lower extremity disability that is related to his active military service. See October 2012 Veteran Correspondence, pp. 1, 3. He contends that he has had constant leg pain and numbness since his discharge. In the alternative, he alleges that this condition is secondary to a nonservice-connected disability. The RO should undertake necessary steps to verify any periods of ACDUTRA and then obtain a VA examination. Although the November 2017 VA examiner found no objective evidence of lumbar radiculopathy or lower extremities peripheral neuropathy, the Veteran was diagnosed with bilateral peroneal neuropathy and bilateral tibial neuropathy by way of EMG/NCV testing in May 2014. See VA Treatment Records, p. 131. Additionally, the Veteran was diagnosed with bilateral sacroiliitis in August 2009 at a time when he was still in the Reserve. The Veteran has not yet been afforded a VA examination in regard to this claim. The Board finds that the Veteran should be afforded a VA examination to clarify the etiology of any currently diagnosed bilateral lower extremity disability. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Entitlement to service connection for an acquired psychiatric disorder, to include as secondary to a nonservice-connected disability, is remanded The Veteran alleges that he has a psychiatric disorder related to his active duty service. See October 2012 Veteran Correspondence, pp. 1, 3. He has reported psychiatric symptoms since his discharge. In the alternative, he contends that his psychiatric disorder is secondary to a nonservice-connected disability. A February 2012 VA treatment record contains a diagnosis of mood disorder secondary to the Veteran’s medical conditions. The Veteran was diagnosed with major depressive disorder and anxiety disorder in August 2013, which was linked to his physical disabilities. See San Juan VAMC Medical Treatment Records, p. 235. With respect to an in-service event, a September 2000 enlistment examination contains a normal psychiatric evaluation, with the clinician noting that no personality or mood disorder was detected. Subsequent to his active service, the Veteran had several negative depression screenings between November 2005 and November 2012. The Veteran has not yet been afforded a VA examination in regard to this claim. The Board finds that the Veteran should be afforded a VA examination to clarify the etiology of any currently diagnosed psychiatric disorder. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 3. Entitlement to service connection for sleep disorder, to include OSA and sleep deprivation, to include as secondary to a nonservice-connected disability, is remanded The Veteran alleges that his sleep disorder is related to his active military service. See October 2012 Veteran Correspondence. In the alternative, he contends that his sleep disorder is secondary to a nonservice-connected disability. Post-service treatment records indicate a diagnosis of OSA. See San Juan VAMC Medical Treatment Records, pp. 49, 149. There is no evidence to indicate that this condition is related to the Veteran’s active service. However, the Veteran’s sleep disorder claim is inextricably intertwined with his bilateral lower extremity disability and psychiatric disability claims remanded herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). 4. Entitlement to service connection for erectile dysfunction, to include as secondary to a nonservice-connected disability, is remanded The Veteran alleges that his erectile dysfunction is related to his active service. In the alternative, he contends that this condition is secondary to medications he is now prescribed for nonservice-connected disabilities See October 2012 Veteran Correspondence, pp. 1, 4. Specifically, the Veteran asserts that his erectile dysfunction is related to the antidepressants that he is taking due to his acquired psychiatric condition and sleep disorder. See San Juan VAMC Medical Treatment Records, p. 227. The Board finds that there is a current disability. The Veteran participated in a Sildenafil Citrate (Viagra) orientation at the Sexuality and Health Clinic in August 2013, and he was prescribed Viagra in November 2013. See San Juan VAMC Medical Treatment Records, p. 227. There is no evidence to indicate that this condition is related to the Veteran’s active service. However, the Veteran’s erectile dysfunction claim is inextricably intertwined with his sleep disorder and psychiatric disability claims remanded herein. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Confirm any periods of ACDUTRA from 2004 to 2012. In this regard, a statement showing only retirement points will not suffice. Written confirmation of these dates should be placed in the claims file. If no such records are available, specific confirmation of that fact should be noted in the claims folder, and the Veteran should be so informed. 2. After the development in paragraph 1 is complete, schedule the Veteran for an appropriate VA examination to determine whether it is at least as likely as not (50 percent or greater probability) that any currently diagnosed bilateral lower extremity disability, to include neuropathy and sacroiliitis, is related to a period of active duty or ACDUTRA. The examiner should consider the relevant treatment records discussed above. The examiner should also address the Veteran’s lay statements. The examiner should set forth the medical reasons for accepting or rejecting the statements of continuity of symptoms since service. 3. After the development in paragraphs 1 and 2 is complete, schedule the Veteran for an appropriate VA examination to determine the following: (a) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed psychiatric disability is related to a period of active duty or ACDUTRA? The examiner should consider the relevant treatment records discussed above. The examiner should also address the Veteran’s lay statements. The examiner should set forth the medical reasons for accepting or rejecting the statements of continuity of symptoms since service. (b) Is it at least as likely as not (50% or higher degree of probability) that any currently diagnosed psychiatric disability is caused or aggravated by a service-connected disability? The examiner is informed that aggravation here is defined as any increase in disability. A separate rationale for all opinions, to include causation or aggravation, is required. 4. Thereafter, if any only if, service connection is established for a psychiatric disability or a bilateral lower extremity disability, schedule the Veteran for an appropriate examination to determine the nature and likely etiology of the Veteran’s sleep apnea. The claims file and copies of all pertinent records should be provided to the examiner for review. The examiner should address the following: Is it at least as likely as not (50% or higher degree of probability) that the Veteran’s sleep apnea is caused or aggravated by a service-connected disability? The examiner is informed that aggravation here is defined as any increase in disability. A separate rationale for all opinions, to include causation or aggravation, is required. 5. Thereafter, if any only if, service connection is established for a psychiatric disability or a sleep disorder, schedule the Veteran for an appropriate examination to determine the nature and likely etiology of the Veteran’s erectile dysfunction. The claims file and copies of all pertinent records should be provided to the examiner for review. The examiner should address the following: Is it at least as likely as not (50% or higher degree of probability) that the Veteran’s erectile dysfunction is caused or aggravated by a service-connected disability or by medication prescribed to treat a service-connected disability? The examiner is informed that aggravation here is defined as any increase in disability. A separate rationale for all opinions, to include causation or aggravation, is required. REBECCA N. POULSON Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. DEEMER, ASSOCIATE COUNSEL