Citation Nr: 18155581 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 16-53 950 DATE: December 4, 2018 REMANDED Entitlement to service connection for a disability manifested by right foot pain is remanded. Entitlement to service connect for a disability manifested by left foot pain is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active duty service from October 2006 to October 2011. The following specified development of this claim is requested below. 1. Entitlement to service connection for a disability manifested by right foot pain is remanded. 2. Entitlement to service connect for a disability manifested by left foot pain is remanded. The Veteran presented forth testimony that there were continuous medical problems and pain at the feet bilaterally resulting from her military occupational specialty (MOS) as a Line Troubleshooter for a helicopter squadron in the U.S. Navy, having routinely been standing for hours at one time on a flight deck. The Veteran indicated not then getting treatment to be able to continue doing the job without any question. Testimony on the above is competent and credible, and based upon that medical history and subsequent reported issues a VA examination is warranted to determine if the claimed conditions are etiologically related to the Veteran’s active military service. 3. Entitlement to service connection for sleep apnea is remanded. By statement upon her October 2016 VA Form 9 (Substantive Appeal to the Board), the Veteran indicated that a prior April 2016 VA examiner (Dr. A. G.) for unrelated conditions, in subsequent conversation they had about the case offered justification for why OSA may have been disability of service origin. The Veteran is encouraged to contact this provider and request any further pertinent detail in written format, to forward via communication with the Veteran or directly to attention of the Regional Office (RO). She also challenged the competency of the VA examiner who conducted the August 2016 VA examination. The August 2016 VA sleep apnea examiner determined that this condition did not have its onset during active duty military service. However, the Veteran since cited medical literature (findings encapsulated within statement provided by her October 2016 VA Form 9) that challenges the reasoning of the April 2016 examiner’s opinion. Additionally, a new lay witness statement from another service member was received. The Veteran essentially having raised some concerns as to the validity of the August 2016 examination, for purpose of accurate findings, the Board will request a supplemental opinion. The matters are REMANDED for the following action: 1. Obtain the Veteran’s most recent VA outpatient treatment records and associate them with the claims folder, if they exist. 2. Schedule the Veteran for an examination with an appropriate clinician to determine the etiology of any disabilities manifested by right and/or left foot pain. The electronic claims file must be provided to and reviewed by the examiner in conjunction with the examination. The examiner should provide a diagnosis as to the current disabilities presently manifested by right and/or left foot pain. Then opine regarding whether it is at least as likely as not (50 percent or greater probability) that the diagnosed condition(s) are etiologically related to service, based upon documented medical history and the Veteran’s competently described in-service injury due to her military occupational duties. The examiner must provide a complete rationale for all opinions expressed. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Provide the Veteran’s claims file to a qualified clinician to determine the etiology of her sleep apnea. The electronic claims file must be provided to and reviewed by the examiner in conjunction with the examination. The examiner is requested to provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that diagnosed sleep apnea is etiologically related to service, based upon documented medical history, the Veteran’s own competently reported medical history, and lay witness statements of record attesting to the Veteran’s in-service and subsequent symptomatology. Although an independent review of the claims file is required, the examiner’s attention is drawn to those points from medical literature, cited in the Veteran’s October 2016 VA Form 9 (Substantive Appeal to the Board) citing generalized factors in the development of sleep apnea, which the Veteran averred are contrary to the findings of the August 2016 VA examination already upon the etiology of sleep apnea. It is further requested the consideration of the August 2016 VA examination report itself as bearing upon causation. The examiner should provide a complete rationale for all opinions expressed. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. (Continued on the next page)   4. Then, readjudicate the claims on appeal based upon all additional evidence received. If any benefit sought on appeal is not granted, the Veteran should be provided with a Supplemental Statement of the Case (SSOC) and an opportunity to respond before the file is returned to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jason A. Lyons