Citation Nr: 18155244 Decision Date: 12/03/18 Archive Date: 12/03/18 DOCKET NO. 16-40 873A DATE: December 3, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. Entitlement to an initial rating in excess of 30 percent for ischemic heart disease (IHD) is remanded. Entitlement to an initial rating in excess of 10 percent for hypertension is remanded. Entitlement to an initial rating in excess of 0 percent for erectile dysfunction (ED) is remanded. REFERRED In his August 2015 Notice of Disagreement (NOD) (VA Form 21-0958), the Veteran wrote that he believed the effective date for the 10 percent rating for hypertension should have been 1984. The RO interpreted this statement as a motion to revise or reverse a prior rating decision on the basis of clear and unmistakable error (CUE), and addressed it in the June 2016 SOC. The Board declines to take jurisdiction of this issue at this juncture. The appeal of the current rating assigned the Veteran’s hypertension does not reasonably encompass the issue of whether there was CUE in a prior rating decision regarding the effective date of the assignment of the 10 percent rating. Thus, any CUE motion must first be addressed in a rating decision. If the Veteran disagrees with that rating decision, he must then file a NOD to initiate the appeal process. See 38 C.F.R. § 20.200 (2017). Accordingly, this issue is referred to the agency of original jurisdiction for appropriate action. REASONS FOR REMAND The Veteran served on active duty from January 1978 to September 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. The Veteran was diagnosed with sleep apnea in July 2014. In an August 2014 VA examination, the examiner opined that the Veteran’s diagnosed OSA was less likely than not related to service. Since that opinion was rendered, the Veteran has stated that he used a positive pressure oxygen mask during service as a Naval Flight Officer/Radar Intercept Officer. He states he has been informed that this may have contributed to his OSA. Moreover, in a July 2018 brief, the Veteran, through his representative, stated that his service-connected posttraumatic stress disorder (PTSD) and ischemic heart disease caused or aggravated his sleep apnea. The Board finds that further medical opinion is warranted to address these newly raised issues. 2. Entitlement to an initial rating in excess of 30 percent for IHD is remanded. 3. Entitlement to an effective date earlier than March 1, 2001 for a rating in excess of 10 percent for hypertension is remanded. The Veteran has not had an examination for IHD or hypertension since October 2013. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his IHD and hypertension. 4. Entitlement to an initial rating in excess of 0 percent for ED is remanded. The Veteran filed a Notice of Disagreement (NOD) with the September 2014 rating decision regarding the denial of a higher rating for ED. He submitted additional medical evidence with the NOD. Thus far, the RO has not taken action on this issue. The RO must readjudicate the issue with consideration of the additional evidence. If the benefits sought continue to be denied, a Statement of the Case (SOC) must be issued. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. Add to the file any outstanding VA treatment records for the Veteran dated since February 2018. 2. Obtain new VA medical opinions regarding service connection for obstructive sleep apnea (OSA), as specified below. Direct service connection: The examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s OSA is related to active service. The examiner should specifically address the Veteran’s statement that his sleep disability is the result of using a positive pressure oxygen mask during service in his capacity as a as a Naval Flight Officer/Radar Intercept Officer. Secondary service connection: If the examiner finds that the Veteran’s OSA is less likely than not related to service, the examiner should provide an opinion as to whether it is at least as likely as not (50% probability or more) that the Veteran’s OSA has been caused or aggravated by his service-connected PTSD with depression, ischemic heart disease, and/or high blood pressure. 3. Schedule the Veteran for a VA examination to determine the current severity and manifestations of his ischemic heart disease. The examiner must review the claims file and should note that review in the report. After conducting an examination of the Veteran and performing any clinically-indicated diagnostic testing, to include metabolic equivalent testing, the examiner should describe all of the symptoms related to the Veteran’s ischemic heart disease. A rationale for all opinions should be provided. If METS testing cannot be conducted because it is medically contraindicated, the examiner should so state and should provide a METS estimation and an explanation for the basis of the estimate. 4. Schedule the Veteran for a VA hypertension examination to determine the current severity and manifestations of his hypertension. The examiner must review the claims file and must note that review in the report. All indicated tests should be conducted. All pertinent symptomatology and findings must be reported in detail. The examiner must provide three diastolic and systolic blood pressure readings for the Veteran, taken during the course of the examination, and with consideration of the entire history, state whether the Veteran’s diastolic pressure has been predominantly 110 or more, or his systolic pressure has been predominantly 200 or more at any time since May 2012. 5. Readjudicate the evaluation of the Veteran’s erectile dysfunction, with consideration of the September 2015 VA Disability Benefits Questionnaire (DBQ) and any other pertinent evidence of record since the September 2014 rating decision was issued. If the benefits sought continue to be denied, the Veteran and his representative must be furnished an SOC. After issuance of the SOC, if the Veteran wishes to proceed with the appeal, he must file a timely substantive appeal in order for this issue to be certified to the Board. J. Rutkin Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. D. Cross, Associate Counsel