Citation Nr: 18156871 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 14-03 718 DATE: December 11, 2018 ORDER Service connection for sleep apnea is denied. Service connection for bilateral carpal tunnel syndrome is denied. REMANDED Service connection for a lumbar spine disability is remanded. Service connection for a cervical spine disability is remanded. Service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to a service-connected disability, is remanded. Service connection for peripheral neuropathy of the bilateral upper extremities, to include as secondary to a service-connected disability, is remanded. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran has sleep apnea due to a disease or injury in service. 2. The preponderance of the evidence is against finding that the Veteran has bilateral carpal tunnel syndrome due to a disease or injury in service. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for bilateral carpal tunnel syndrome are not met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board had active service from January 1985 to June 1992. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. 1. Sleep apnea The Veteran claims that his sleep apnea is etiologically related to his service. However, the Veteran has not provided any contentions as to how his sleep apnea was caused or aggravated by his service. The service treatment records are negative for indication of sleep apnea. The first indication of a diagnosis of sleep apnea was not until a 2008 sleep study that showed minimal sleep apnea. VA treatment records reflect that in April 2001, the Veteran reported daytime sleepiness for one year, which was unusual for him as he had been able to get a good night sleep throughout his life. The Board notes that in June 2000, the Veteran reported experiencing fatigue since returning from service. However, he did not report trouble with sleep at that time. On January 2015 VA examination, the Veteran confirmed that his sleep trouble was more recent, and reported interrupted sleep for the previous five years. On April 2018 VA examination, the examiner concluded that it was less likely than not that the Veteran’s sleep apnea was related to his service, as, per the Veteran’s self-report, his sleep apnea symptoms did not begin until well after he separated from service. Given the above evidence, to include an absence of symptoms in service or for many years following service separation, as well as the negative VA opinion obtained in 2018 that is consistent with the record, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for sleep apnea. Significantly, the Veteran has not provided statements that would relate his sleep apnea to his service, and the post-service treatment records reflect his report that prior to 2000, he did not experience or notice sleep trouble. 2. Bilateral carpal tunnel syndrome The Veteran claims that his carpal tunnel syndrome is etiologically related to his service. However, the Veteran has not provided any contentions as to how his carpal tunnel syndrome was caused or aggravated by his service. The service treatment records are negative for indication of carpal tunnel syndrome. The first indication of neurological symptoms in the hands or arms is not until six years following service separation, in 1998. At that time, the Veteran underwent an x-ray of the cervical spine due to reports of tingling in the arms and hands. He had reported some tingling in his hands that was on and off. A diagnosis was not made at that time. In 2006, the Veteran reported symptoms of numbness and tingling in the left hand and arm for about three years. He was evaluated for carpal tunnel syndrome. These records do not relate the Veteran’s carpal tunnel syndrome to his service either through a showing continuity since service or by way of a medical nexus to service. In that regard, on April 2018 VA examination, the examiner opined that the Veteran’s carpal tunnel syndrome was less likely than not related to his service. The examiner noted that the Veteran reported symptoms of carpal tunnel syndrome that began many years following service separation. Given the above evidence, to include an absence of symptoms in service or for years following service separation, as well as the negative VA opinion obtained in 2018 that is consistent with the record, the Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for bilateral carpal tunnel syndrome. While the Veteran reported some tingling in his hands in 1998, six years following service, evaluation for carpal tunnel syndrome was not indicated at that time. His symptoms were instead thought to be related to a disability of the cervical spine or possibly rheumatoid arthritis, though neither were diagnosed. The first indication of a carpal tunnel syndrome etiology was not until 2006, 14 years following service separation, and the medical evidence did not relate carpal tunnel syndrome to service. Thus, the Board finds that in-service onset, continuity of symptoms, and a medical nexus have not been demonstrated in this case. REASONS FOR REMAND The Veteran contends that his lumbar spine disability is etiologically related to his service. Both the service treatment records and post-service treatment records demonstrate multiple complaints of low back pain, such that a VA opinion is necessary in this instance. Although a VA examination and opinion was obtained in May 2018, the opinion did not discuss specific records which the Board has identified in the remand directives below. The Veteran also contends that his cervical spine disability is etiologically related to his service. For the same reasons, the Board finds that a new VA examination and opinion is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any lumbar spine disability, cervical spine disability, and related neurological manifestations in the upper and/or lower extremities. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. For the lumbar spine, the examiner should consider the service treatment records that show that in August 1991, the Veteran experienced back pain after a motor vehicle accident, in November 1992, the Veteran experienced a back ache after a fall, and as part of a 1991 or 1992 medical board proceeding, the Veteran reported experiencing lower back pains. The examiner should consider that on October 1994 VA examination, the Veteran reported experiencing back pain since 1987. On that examination, the Veteran was assessed to suffer from lower back pain, but had otherwise normal x-rays and findings. For the cervical spine, the examiner should consider the 1998 Gulf War VA examination when the Veteran reported numbness and tingling in the hands and therefore underwent a cervical spine x-ray, the Veteran’s report on October 1999 VA examination that he has experienced occasional neck pain, and the diagnosis of mild degenerative joint disease and disc herniation on 2000 CT scan. (Continued on the next page)   A complete rationale must be provided for any opinions offered. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Erdheim, Counsel