Citation Nr: 18154676 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-05 412 DATE: November 30, 2018 REMANDED Service connection for a right thumb disability is remanded. Service connection for a sleep disability is remanded. Service connection for left ear hearing loss is remanded. Service connection for tinnitus is remanded. Service connection for hemorrhoids is remanded. Service connection for a right elbow disability is remanded. Service connection for a right ankle disability is remanded. Service connection for a left ankle disability is remanded. Service connection for a left foot disability is remanded. A disability rating in excess of 50 percent for depression with posttraumatic stress disorder (PTSD) is remanded. An initial compensable disability rating for allergic rhinitis is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1983 to August 1983 and May 1986 to June 2001 in the United States Army. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). With regard to the claim for sleep disability, the RO previously denied a claim for obstructive sleep apnea in an November 2007 rating decision. A determination as to whether the Veteran’s present claim is properly characterized as a claim for service connection or an application to reopen a previously denied claim would be premature, given that additional development is required and further medical evidence may be received concerning the Veteran’s diagnosis. See, e.g., Boggs v. Peake, 520 F.3d 1330 (Fed. Cir. 2008) (claims based upon distinctly and properly diagnosed diseases or injuries cannot be considered the same claim.) A remand of the appeal is required for several reasons. Initially, in October 2018, the Board sent the Veteran a letter to ask whether he waived his right to have the case remanded to the RO for initial review of evidence associated with the file by VA since the July 2016 supplemental statement of the case (SSOC). He was advised that if he did not respond to the letter within 45 days, the case would be remanded for initial RO review of the evidence. As a reply was not received, the appeal must be remanded for this purpose. Also, in January 2010, the Veteran asked VA to obtain the private medical records of Dr. O. from Pearland Family Medicine, and in September 2017, he asked VA to obtain the private medical records of Dr. R. from iMed Physicians Network. Insufficient attempts, or no attempts, to obtain these records were made. A remand is required to request these records. VA examinations are needed for several of the claims for service connection. Service treatment records show complaints and treatment pertinent to hemorrhoids (1983, January 2001, and February 2001), a right elbow disability (December 1992), right ankle disability (April 1995, May 1995), a left ankle disability (July 1995), and left foot disability (February 1988, February 2001). An August 2010 private treatment record documents current hemorrhoids, and the Veteran has reported pain with functional impairment of the right elbow, right ankle, left ankle, and left foot. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). While VA examinations were previously provided in 2010 and 2011, the examiner’s opinion regarding hemorrhoids was premised on a finding of no current hemorrhoid residuals, and findings on the orthopedic disabilities were premised on the absence of a current diagnosis of arthritis. Further medical opinions are needed. Additionally, VA examinations are needed for the claims for higher ratings. The Veteran has reported that his psychiatric disability and allergic rhinitis have worsened since he was last examined by VA in 2010 and 2011, respectively. While on remand, updated examinations should be provided. The matters are REMANDED for the following action: 1. Ask the Veteran to complete VA Forms 21-4142 for Dr. O. of Pearland Family Medicine, and Dr. R. of iMed Physicians Network. Make two requests for the authorized records from these providers, unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for an examination to address the nature and etiology of his hemorrhoids, and disabilities of the right elbow, right ankle, left ankle, and left foot. The examiner must opine on whether it is at least as likely as not that the current hemorrhoids, and disabilities of the right elbow, right ankle, left ankle, and left foot are related to an in-service injury, event, or disease. In rendering his/her opinion, the examiner must consider the service treatment records showing complaints and treatment pertinent to hemorrhoids (1983, January 2001, and February 2001), a right elbow disability (December 1992), right ankle disability (April 1995, May 1995), a left ankle disability (July 1995), and left foot disability (February 1988, February 2001). 3. Afford the Veteran a VA examination to ascertain the current severity of his depression with PTSD, in accordance with the applicable worksheet for rating the disability. 4. Afford the Veteran a VA examination to ascertain the current severity of his allergic rhinitis, in accordance with the applicable worksheet for rating the disability. (Continued on the next page)   5. As a response was not received to VA’s October 2018 letter, readjudicate the claims considering all evidence, including all records associated with the file since the July 2016 SSOC. If the benefits sought remain denied, provide a SSOC. M. Tenner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Smith, Counsel