Citation Nr: 18155636 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 14-20 194 DATE: December 4, 2018 REMANDED Entitlement to service connection for obstructive sleep disorder (OSA) is remanded. Entitlement to service connection for back condition is remanded. Entitlement to service connection for neck condition is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1960 to March 1964. This matter is on appeal from a September 2013 rating decision for obstructive sleep apnea (OSA), back condition, and neck condition. The Board remanded this appeal in July 2017 for additional development. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c). 38 U.S.C. § 7107(a)(2). A hearing was held in March 2017 before the undersigned Judge; a transcript of that hearing has been associated with the claims file. The Veteran contends that his conditions was caused by his active duty service. Based upon review of the Veteran’s March 2017 Hearing testimony, June 2013 and August 2017 examination for OSA, back condition, and neck condition, the Board finds that additional record development and opinion clarification is necessary before adjudicating the Veteran’s claim. The Veteran asserts that his conditions arose out of an injury he sustained playing football during his active duty service. The Veteran’s service treatment records show in November 1961 the Veteran was treated for injuries sustained in a collision playing football including lacerations above his left eye and headaches. In an April 2006 submitted lay statement, the Veteran states that after his injury from the football collision in service, he suffered bad headaches nearly every day. In an April 2013 Statement in Support of Claim, the Veteran states that he had surgery to correct his OSA by repairing one side of his nose “that had been crushed” and tissue in his throat. In the March 2017 hearing, the Veteran testifies that at a visit for a meeting to correct snoring and follow up examination at a Rockville County Hospital revealed “one side of [the Veteran’s] nose is totally crushed” and the Veteran could not breath through his nose on that side. In a June 2013 private examination with Dr. T., the doctor states the Veteran underwent surgery to treat his nasal septum and OSA in the 1990’s, but did not have records of this treatment, and instructed the Veteran to obtain these records. The doctor notes that while the Veteran’s nasal trauma caused while in active service was “probably the case”, he did not have any records for confirmation. A review of the claims file does not show records of the Veteran’s examination regarding his nose and surgery as cited by Dr. T. In the March 2017 hearing, the Veteran testified that he started having back and neck problems in the late 1960s, and at the time he was seeing a medical doctor and a chiropractor for treatment. A review of the claims file does not show records of the Veteran’s treatment by this medical doctor or chiropractor. Thus, it appears there are outstanding treatment records, and a remand is necessary in order to obtain those records and any other outstanding private or VA treatment records. The Veteran was afforded an August 2017 VA Examinations for sleep apnea, back condition and neck condition. The VA examiner for sleep apnea opined the Veteran’s current sleep apnea diagnosis was due to obesity. The examiner further stated there was no objective evidence to support the Veteran’s assertions of receiving surgery in the 1990s for septal deviation and OSA as referred to by Dr. T.; and the examiner opines even if true, the Veteran’s listed injury to his left eye as stated in the service treatment record is not related to this treatment. Although the Veteran’s weight may be relevant to his sleep apnea, the examiner must also consider if the Veteran’s condition may be related to other factors or events, to also include his in-service injury and other indicators during service or any time after service before the Veteran’s sleep diagnosis. The VA examiner for back and neck condition opined it was less likely than not the Veteran’s conditions were related to service; citing no service treatment record entries for either condition and that the Veteran’s complaints arose years after separation from service. However, the Board notes that the examiner never provided a clear, reasoned analysis addressing the records in the claims file to make the opinion. Despite the Board remanding this case in July 2017 to the examiner with instructions to specifically address in detail the Veteran’s in-service head injury, the examiner failed to do so. In fact, it appears the examiner copied and pasted the same conclusion for both back and neck opinions. In light of the outstanding records of the Veteran’s treatment with the chiropractor and for nasal septum surgery for OSA, the Board finds that further clarification of the opinions is needed. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated and outstanding treatment records. 2. Request that the Veteran provide the names and addresses of any and all healthcare providers who provided treatment for his sleep apnea, back and neck condition; In particular, records of treatment for back and neck with the Veteran’s chiropractor after service, and regarding his surgery for septoplasty and sleep apnea in the 1990’s. After acquiring this information and obtaining any necessary authorization, obtain and associate any pertinent records with the claims folder. 3. Return the claims file to the VA examiners who conducted the August 2017 examinations, if available, for clarification and additional opinions. After review of the claims file, to include the previous findings in the August 2017 examination, the examiner is asked to respond to the following: (a.) Provide an opinion clarifying whether the sleep apnea is less likely or not caused by the in-service injury, event or illness. The examiner should see if there are there any clinical indicators of sleep apnea were present in the past, for example, during service or any time after service but before a formal sleep diagnosis. The examiner should identify any such clinical indicators beyond the obesity of the Veteran and explain whether they might support a sleep apnea diagnosis. (b.) Provide an opinion clarifying whether the back condition and neck condition is less likely or not caused by the in-service injury, event or illness. The examiner must specifically answer the instructions as given in the July 2017 Board Remand in their opinion. A complete rationale for all opinions expressed should be provided. 4. After completion of the above and any additional development deemed necessary, the issues on appeal should be reviewed with consideration of all applicable laws and regulations. If any benefit sought remains denied, the Veteran should be furnished a supplemental statement of the case and be afforded the opportunity to respond. Thereafter, the case should be returned to the Board for appellate review, if in order. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Yang, Law Clerk