Citation Nr: 18153969 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 17-31 946 DATE: November 28, 2018 REMANDED The issue of service connection for sleep apnea is remanded. The issue of service connection for a right hip disorder is remanded. The issue of service connection for a left hip disorder is remanded. The issue of service connection for a right hand disorder is remanded. The issue of service connection for a left hand disorder is remanded. The issue of service connection for a right arm disorder is remanded. The issue of service connection for a left arm disorder is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army from September 1985 to January 1986, from December 1990 to July 1991, and from January 2003 to January 2004. She had additional service with the U.S. Army Reserve. She served in Southwest Asia. This appeal is before the Board of Veterans’ Appeals (Board) from a February 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The issue of service connection for sleep apnea is remanded. Remand is necessary to obtain a new VA medical opinion because the October 2015 opinion is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The opinion states that the Veteran had a complaint of sleep difficulty in service and attributed it to a time zone change. However, in December 2003, the Veteran reported only sleeping about 4 hours per night. The reports of a May 2013 VA posttraumatic stress disorder (PTSD) examination and the October 2015 VA sleep apnea examination indicate that the Veteran continued to report sleeping only 4 hours per night. The examiner’s incorrect statement about sleep difficulty only relating to a time zone change indicates that the examiner was not familiar with the record. Additionally, the examiner indicated that, because obesity is a strong risk factor for sleep apnea in most individuals, it must be the cause of this Veteran’s disorder. The examiner also failed to address whether the Veteran’s sleep apnea was caused or aggravated by her service-connected PTSD, despite VA examination reports and treatment records indicating that she had sleep disturbances associated with her PTSD. The examiner also failed to address whether the Veteran’s in-service exposure to chemicals and toxins while in service in Southwest Asia caused her sleep apnea. Lastly, the examiner stated that “[t]here is no evidence within her [service treatment records] that provide a nexus of the claimed condition due to a specific or aggregate of exposure in Southwest Asia.” There is no requirement that service treatment records indicate a nexus to service in order to find the disorder is connected to service. The issue of service connection for a right hip disorder is remanded. In the report of the October 2015 VA examination, the examiner indicated that the Veteran did not have pain with weight-bearing or objective evidence of localized tenderness or pain on palpation. The examination report also includes a paragraph written by the examiner about work-related limitations the Veteran had due to hip pain. This report is internally inconsistent and is, therefore, remand for clarification is necessary. The issue of service connection for a left hip disorder is remanded. The October 2015 VA examination report did not indicate whether the Veteran had left hip complaints or a left hip disorder. Remand is necessary to clarify. The issue of service connection for a right hand disorder is remanded. The issue of service connection for a left hand disorder is remanded. The report of an October 2015 VA examination indicates that the Veteran had right and left wrist arthritis. She had in-service complaints of a painful wrist, swollen or painful joints, and muscle aches. No opinion has been advanced as to whether it was caused by service or whether any other right and/or left hand complaints are of an unknown etiology. Remand is necessary to obtain the medical opinions. The issue of service connection for a right arm disorder is remanded. The issue of service connection for a left arm disorder is remanded. The report of an October 2015 VA examination indicates that the Veteran had left elbow lateral epicondylitis. She had in-service complaints of a painful wrist, swollen or painful joints, and muscle aches. The examination report did not indicate whether she any right arm complaints or disorders and it did not provide any opinions as to whether the left elbow disorder was caused by service. Therefore, remand is necessary. The matter is REMANDED for the following action: 1. Obtain an opinion as to the nature and etiology of the Veteran’s sleep apnea from an examiner other than the one who provided the October 2015 opinion. If necessary to respond to the inquiries below, schedule her for a VA sleep apnea examination. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether sleep apnea was caused by any in service event, injury, disease, or disorder, including exposure to chemicals and toxins while stationed in Southwest Asia, or in any way originated during service. (b.) Whether the Veteran’s ongoing complaints of only being able to sleep 4 hours per night, which began in December 2003, indicate that sleep apnea arose during service. (c.) Whether sleep apnea was caused by the Veteran’s service-connected PTSD. (d.) Whether sleep apnea was aggravated by the Veteran’s service-connected PTSD. (e.) Whether there is a known etiology of the Veteran’s sleep apnea. 2. Return the file to the VA examiner who conducted the October 2015 examination. If the examiner is not available, have the file reviewed by a similarly-qualified examiner. If necessary to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of any right and/or left hip disorder. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether the Veteran has a left hip disorder. (b.) Whether any diagnosed left hip disorder was caused by any in-service injury, disease, disorder, or event, or in any way originated during service. (c.) Whether any diagnosed left hip disorder has no conclusive pathophysiology or etiology. (d.) Whether the Veteran has left hip complaints but no diagnosis. (e.) Whether any left hip complaints are the result of an undiagnosed illness or MUCMI. (f.) Whether the Veteran has right hip pain. 3. Return the file to the VA examiner who conducted the October 2015 examination. If the examiner is not available, have the file reviewed by a similarly-qualified examiner. If necessary to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of any right or left hand disorders. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether any right and/or left hand disorder, including right and left wrist arthritis, was caused by any in-service event, injury, disease, or disorder, or in any way originated during service. (b.) Whether right and/or left wrist arthritis manifested to a compensable degree within one year of service separation. (c.) Whether right and/or left wrist arthritis is without a conclusive pathophysiology or etiology. (d.) Whether the Veteran has other right and/or left hand complaints which have no diagnosis. (e.) Whether any other right and/or left hand complaints are the result of an undiagnosed illness or MUCMI. 4. Return the file to the VA examiner who conducted the October 2015 examination. If the examiner is not available, have the file reviewed by a similarly-qualified examiner. If necessary to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of any right or left arm disorders. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Whether left elbow lateral epicondylitis was caused by any in-service event, injury, disease, or disorder, or in any way originated during service. (b.) Whether any other diagnosed left and/or right arm disorder was caused by any in-service event, injury, disease, or disorder, or in any way originated during service. (c.) Whether left elbow lateral epicondylitis is without a conclusive pathophysiology or etiology. (d.) Whether the Veteran has any other diagnosed left and/or right arm disorder without a conclusive pathophysiology or etiology. (e.) Whether the Veteran has right and/or left arm complaints but no diagnosis. (f.) Whether any right and/or left arm complaints are the result of an undiagnosed illness or MUCMI. 5. Readjudicate the issues on appeal. If any benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case. An appropriate period should be allowed for response before the case is returned to the Board. J. GALLAGHER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. E. Miller, Associate Counsel