Citation Nr: 18156680 Decision Date: 12/10/18 Archive Date: 12/10/18 DOCKET NO. 15-44 701 DATE: December 10, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) and depression is remanded. Entitlement to a rating in excess of 10 percent for a low back disability is remanded. Entitlement to a rating in excess of 10 percent for compartment syndrome (muscle disability) of the right lower extremity is remanded. Entitlement to a rating in excess of 10 percent for a muscle disability of the left lower extremity is remanded. Entitlement to a compensable rating for hypertension with headaches is remanded.   REASONS FOR REMAND 1. Entitlement to service connection for sleep apnea is remanded. 2. Entitlement to service connection for an acquired psychiatric disability is remanded. 3. Entitlement to a rating in excess of 10 percent for a low back disability is remanded. 4. Entitlement to a rating in excess of 10 percent for compartment syndrome of the right lower extremity is remanded. 5. Entitlement to a rating in excess of 10 percent for compartment syndrome of the left lower extremity is remanded. 6. Entitlement to a compensable rating for hypertension with headaches is remanded. The Veteran served on active duty in the Army from September 2001 to March 2002, from December 2003 to March 2005 and from October 2006 to June 2009. It appears that there are outstanding service treatment records, namely those from the Veteran’s first two periods of service as the record only contains STRs from June 2005 to April 2009. These records are potentially relevant to the service connection claims and must be obtained. Additionally, although the Veteran failed to report to VA examinations scheduled in 2014 to determine the severity of his back disability; left and right lower extremity muscle disabilities; and his hypertension, in light of the need for remand, the Board finds the Veteran should be given another opportunity to undergo VA examinations to determine the current degree of severity of the service-connected disabilities. The Board notes that the record contains an August 2016 private psychiatric opinion and an October 2016 private sleep apnea opinion; however, the Board is the medical opinions are inadequate. In this regard, the August 2016 positive nexus opinion is unclear as it indicates that the Veteran’s back, lower extremities, nose, hypertension and left foot disabilities “cause his depressive disorder due to another medical condition…” Further, the October 2016 opinion provides a positive secondary nexus opinion that depression and rhinitis “aided in the development of and permanently aggravate” the Veteran’s obstructive sleep apnea; however, neither the Veteran’s depression or rhinitis are service connected. In light of the foregoing, remand is warranted. The matters are REMANDED for the following action: 1. Undertake appropriate development all outstanding service treatment records, including for the periods September 2001 to March 2002, from December 2003 to March 2005 and from October 2006 to June 2009. If records are unavailable, the AOJ should document the efforts made and the Veteran should be provided notification. 2. Then, afford the Veteran VA examination(s) to determine the nature and etiology of his acquired psychiatric disability and obstructive sleep apnea. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed.   The examiner(s) should opine: a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s acquired psychiatric disability had its onset during active service; otherwise originated during active service; or is related to any incident of service; b) Whether it is at least as likely as not that the Veteran’s acquired psychiatric disability has been aggravated by his service-connected disabilities. If aggravation of the acquired psychiatric disability is found, the examiner should attempt to identify the baseline level of the back disability that existed before aggravation by the service-connected disabilities. c) Whether it is at least as likely as not that the Veteran’s sleep apnea had its onset during active service; otherwise originated during active service; or is related to any incident of service. d) Whether it is at least as likely as not that the Veteran’s sleep apnea has been aggravated by any service-connected disabilities. If aggravation of sleep apnea is found, the examiner should attempt to identify the baseline level of the back disability that existed before aggravation by the service-connected disability or disabilities. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left and right lower extremity muscle disabilities. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected hypertension. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. 5. Schedule the Veteran for an examination of the current severity of his back disability. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 6. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Hemphill, Associate Counsel