Citation Nr: 18153246 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 17-07 430 DATE: November 27, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1964 to March 1968. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston Texas. The Veteran was informed of this right to a personal hearing before the Board, but he declined. 1. Entitlement to service connection for an acquired psychiatric disorder is remanded. The Veteran contends that he is entitled to service connection for an acquired psychiatric disorder. The Veteran was evaluated by a private psychologist in November 2016. The psychologist diagnosed the Veteran with an acquired psychiatric disorder and opined that it was related to the Veteran’s period of service. The Veteran also submitted multiple pieces of medical literature in support of his claim. This is sufficient to trigger VA’s duty to assist, and this matter must be remanded in order to provide the Veteran with a VA examination. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to service connection for sleep apnea is remanded. The Veteran contends that he is entitled to service connection for sleep apnea. The Veteran was evaluated by a private physician in February 2017. The physician diagnosed the Veteran with sleep apnea and opined that his sleep apnea was due to his acquired psychiatric disorder. The Veteran also submitted treatment records diagnosing the Veteran with sleep apnea. Finally, the Veteran submitted medical literature discussing the relationship between sleep apnea and acquired psychiatric disorders. This is sufficient to trigger VA’s duty to assist, and this matter must be remanded in order to provide the Veteran with a VA examination. See McLendon. 3. Entitlement to service connection for headaches is remanded. The Veteran contends that he is entitled to service connection for headaches. The Veteran’s service treatment records indicate that upon induction into service the Veteran reported a history of frequent headaches since childhood, but the Veteran’s head, sinuses, and neurological system were evaluated as normal; and no defects or diagnoses related headaches were noted in the induction examination. The Veteran also sought treatment for headaches during his period of service including in June 1964 and June 1967. The Veteran was evaluated by a private physician in December 2016. The physician diagnosed the Veteran with tension headaches and opined that his headaches due to his acquired psychiatric disorder. Finally, the Veteran submitted medical literature discussing the relationship between headaches and acquired psychiatric disorders. This is sufficient to trigger VA’s duty to assist, and this matter must be remanded in order to provide the Veteran with a VA examination. See McLendon. Additionally, VA must determine whether or not the Veteran’s headaches preexisted service, and, if so, whether or not they were aggravated by a period of service. 38 C.F.R. § 3.304. The matters are REMANDED for the following action: 1. Arrange to provide the Veteran with a VA examination in order to answer the following questions: (a.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between a current diagnosis of an acquired psychiatric disorder and an in-service incurrence? Why or why not? (b.) What is the significance, if any, of the November 2016 private disability questionnaire and attached medical opinion indicating that the Veteran’s acquired psychiatric disorder was related to a period of service? Why? (c.) What is the significance, if any, of the medical literature submitted by the Veteran suggesting a link between military service and depression including: Peter C. Britton, Paige C. Ouimette, & Robert M. Bossarte, The effect of depression on the association between military service and life satisfaction, Springer Science+Business Media B.V. (December 22, 2011); Craig J. Bryan, Chad E. Morrow, Neysa Etienne, & Bobbie Ray-Sannerud, Guilt, Shame, and Suicidal Ideation In A Military Outpatient Clinical Sample, Depression and Anxiety 30:55-60 (2013); Elizabeth Savoca & Robert Rosenheck, The Civillian Labor Market Experiences of Vietnam-Era Veterans: The Influence of Psychiatric Disorders, J. Mental Health Policy Econ. 3, 199-207 (2000)? Why? 2. Arrange to provide the Veteran with a VA examination in order to answer the following questions: (a.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between a current diagnosis of sleep apnea and an in-service incurrence? Why or why not? (b.) Is it at least as likely as not (50 percent or more) that the Veteran’s sleep apnea was proximately due to or aggravated by the Veteran’s acquired psychiatric disorder? Why or why not? (c.) What is the significance, if any, of the February 2017 private disability questionnaire indicating that the Veteran’s sleep apnea was caused by his sleep apnea? Why? (d.) What is the significance, if any, of the medical literature submitted by the Veteran suggesting a link between sleep apnea and depression including: Amir Sharafkhaneh, Nilgun Giray, Peter Richardson, Terry Young, & Max Hirshkowitz, Association of Psychiatric Disordersw and Sleep Apnea in a Large Cohort, SLEEP, Vol. 28, No. 11 (2005)? Why? 3. Arrange to provide the Veteran with a VA examination in order to answer the following questions: (a.) Is it clear and unmistakable (obvious or manifest) that the Veteran’s current diagnosis of headaches pre-existed a period of service? Why or why not? Note that clear and unmistakable is a much higher standard of proof than at least as likely as not. At least as likely as not merely means (50 percent or more) while clear and unmistakable means that there is so much evidence that it is (obvious or manifest) that it is the case. (b.) Is it clear and unmistakable (obvious or manifest) that the Veteran’s headaches were not aggravated by a period of service? Why or why not? Note that clear and unmistakable is a much higher standard of proof than at least as likely as not. At least as likely as not merely means (50 percent or more) while clear and unmistakable means that there is so much evidence that it is (obvious or manifest) that it is the case. (c.) What is the significance, if any, of the fact that the Veteran sought treatment for headaches multiple times during his period of service including in June 1964 and June 1967? Why? (d.) Is it at least as likely as not (50 percent or more) that a medical nexus exists between a current diagnosis of headaches and an in-service incurrence? Why or why not? (e.) Is it at least as likely as not (50 percent or more) that the Veteran’s headaches were proximately due to or aggravated by the Veteran’s acquired psychiatric disorder? Why or why not? (f.) What is the significance, if any, of the December 2016 private disability questionnaire indicating that the Veteran’s headaches were caused by his sleep apnea? Why? (g.) What is the significance, if any, of the medical literature submitted by the Veteran suggesting a link between sleep apnea and depression including: Christina I. Deligianni, Michail Vikelis, & Dimos D. Mitsikostas, Depression in headaches: chronification, Wokker Kluwer Health (2012)? Why? 4. Then, readjudicate the claims on appeal. If the benefits sought are not granted, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate opportunity to respond thereto before returning the case to the Board, if in order KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David R. Seaton, Associate Counsel