Citation Nr: 18153323
Decision Date: 11/27/18	Archive Date: 11/27/18

DOCKET NO. 16-48 160
DATE:	November 27, 2018
REMANDED
Entitlement to service connection for a left ankle disorder is remanded.
Entitlement to service connection for a right ankle disorder is remanded.
Entitlement to service connection for sleep apnea is remanded.
REASONS FOR REMAND
1. Entitlement to service connection for left and right ankle disorders is remanded.
The Veteran underwent a VA examination in July 2015 and was diagnosed with bilateral ankle osteoarthritis and tendonitis.  He asserts that his bilateral ankle disorders are secondary to his service-connected bilateral knee disabilities.  See June 2018 Appellate Brief.  The July 2015 examiner provided an opinion addressing the causation prong of secondary service connection, but failed to address aggravation.  El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). A new opinion must be obtained that addresses all theories of entitlement to service connection.


2. Entitlement to service connection for sleep apnea.
A July 2015 VA treatment record shows a diagnosis of moderate positional sleep apnea.  The Veteran asserts that his sleep apnea is secondary to his service-connected PTSD.  See September 2016 Form 9.  There is no medical opinion of record addressing secondary service connection for sleep apnea.  An opinion should be obtained.
The matter is REMANDED for the following action:
1. Return the Veteran’s file to the examiner who completed the July 2015 ankle examination.  If the examiner is not available, provide the Veteran’s file to an examiner with the appropriate knowledge and expertise.  The examiner must acknowledge review of the pertinent evidence of record, including the Veteran’s reports of symptom manifestation.  All necessary examinations, tests, and studies should be conducted.
The examiner should address the following:
a. Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left ankle disorder was caused or aggravated (worsened) by his service-connected left knee disability?
b. Is it at least as likely as not (50 percent probability or greater) that the Veteran’s right ankle disorder was caused or aggravated (worsened) by his service-connected right knee disability?


Rationale for the requested opinions shall be provided.  If the examiner cannot provide an opinion without resorting to mere speculation, provide an explanation stating why this is so.  In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or the limits of current medical knowledge with respect to the question.
2. Schedule the Veteran for a VA examination to determine the nature and etiology of his sleep apnea.  The examiner must acknowledge review of the pertinent evidence of record, including the Veteran’s reports of symptom manifestation.  All necessary examinations, tests, and studies should be conducted.
The examiner should address the following:
Is it at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea was caused or aggravated (worsened) by his service-connected PTSD?
Rationale for the requested opinion shall be provided.  If the examiner cannot provide an opinion without resorting to mere speculation, provide an explanation stating why this is so.  In so doing, the examiner shall explain whether the inability to provide a more definitive opinion 



is the result of a need for additional information or the limits of current medical knowledge with respect to the question.

 
 MICHAEL A. HERMAN
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Alhinnawi, Associate Counsel