Citation Nr: 18157069 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 14-43 578 DATE: December 11, 2018 REMANDED Service connection for sleep apnea, to include as secondary to PTSD, is remanded. Service connection for diabetes, to include as secondary to hypertension, is remanded. REASONS FOR REMAND The Veteran served from October 1989 to March 2001. These matters come before the Board of Veterans’ Appeals (Board) from a June 2013 rating decision of the Department of Veterans’ Affairs (VA) Regional Office (RO) in Denver, Colorado, which denied the Veteran’s claims for service connection for his sleep apnea and diabetes. The Veteran was scheduled for a March 2018 video conference hearing before a Veterans Law Judge. However, in February 2018, the Veteran stated during a telephone call stated he no longer wished to attend the hearing. 1. Service connection for sleep apnea is remanded. The Veteran generally claims that he currently has sleep apnea that is related to service. He is now in receipt of service connection for PTSD. The Veteran has reported trouble with sleep. In the June 2014 VA mental health assessment, the Veteran reported not being able to sleep and being alert throughout the night, explaining that his war training taught him “to be alert at all times to seek and destroy.” A November 2014 VA assessment addendum states that the Veteran reported “significant sleep disruption such as falling asleep and staying asleep. He estimated getting four hours [of] sleep maximum per night when he takes his medication, and not being able to sleep at all if he does not take his sleep medication … due to racing thoughts and seeing disturbing images.” The Veteran wears a CPAP breathing device at night while sleeping. In November 2012, the Veteran underwent a private sleep study that diagnosed him with obstructive sleep apnea/hypopnea syndrome with hypersomnolence. This sleep study did not address whether the Veteran’s sleep apnea was related to or due to his service, or whether it was caused or aggravated by his service connected PTSD. The evidence of record suggests that the Veteran’s claimed sleep apnea disability may be related to service or his service connected PTSD; however, he has not been afforded a VA examination to determine the etiology of diagnosed sleep apnea. Accordingly, the Board finds that a remand is necessary to afford the Veteran a VA examination. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In addition, although sleep impairment is a symptom of PTSD, the issue of whether the Veteran has sleep apnea that is either caused or aggravated by his service connected PTSD has been raised by the evidence of record and should therefore be addressed in the medical opinion being obtained on remand. 38 C.F.R. § 3.159(c)(4)(i)(C) (VA examination warranted where the evidence indicates that a current disability may be associated with another service connected disability). 2. Service connection for diabetes mellitus type 2 is remanded. The Veteran generally claims that he currently has diabetes that is related to service. He is now in receipt of service connection for hypertension. In a June 2014 VA nutrition evaluation, the Veteran was diagnosed with diabetes. Conversely, a July 2014 VA primary care note stated that there was no justification to support a diagnosis of diabetes as the diabetes “was resolved/inactivated.” A November 2017 VA prime urgent care note assessed the Veteran as someone with “pre-diabetes.” Given that the medical records are conflicting and that the latest record on file is over a year old, it is unclear whether the Veteran currently has diabetes. The Veteran has not been afforded a VA examination in connection with his claim for service connection for diabetes. A definitive diagnosis is not required in order to warrant a VA examination in connection with a claim for service connection. Rather, if there are persistent or recurrent symptoms that may be associated with service, an examination is warranted. 38 U.S.C. § 5103A(d). Accordingly, the Board finds that a remand is warranted to afford the Veteran a VA examination as to the nature and etiology of his diabetes. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). In addition, the issue of whether the Veteran has diabetes that is either caused or aggravated by his service connected hypertension has been raised by the evidence of record and should therefore be addressed in the medical opinion being obtained on remand. 38 C.F.R. § 3.159(c)(4)(i)(C) (VA examination warranted where the evidence indicates that a current disability may be associated with another service connected disability). Furthermore, because diabetes is a chronic disease, the examiner should also address whether diabetes manifested within the one-year presumptive period. These matters are REMANDED for the following action: 1. Schedule the Veteran for VA examination as to the etiology of his sleep apnea. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should indicate, for any diagnosed sleep disorder, whether: (a.) It is at least as likely as not (50 percent or greater probability) that the sleep disorder is related to the Veteran’s service. (b.) It is at least as likely as not that a sleep disorder is caused by the Veteran’s service-connected PTSD. (c.) It is at least as likely as not that the sleep apnea disability is aggravated by the Veteran’s service-connected PTSD. If aggravation is found, the baseline level of disability prior to aggravation should be identified to the extent possible. The examiner should provide a complete rationale for any opinion set forth. 2. Schedule the Veteran for VA examination as to the nature and etiology of his diabetes. All necessary tests should be conducted. The claims file must be sent to the examiner for review. The examiner should first indicate whether there is a diagnosis of diabetes. If so, the examiner should indicate whether: (a.) It is at least as likely as not (50 percent or greater probability) that the diabetes is related to the Veteran’s service or manifested within a year of separation from service. (b.) It is at least as likely as not that the diabetes is caused by the Veteran’s service-connected hypertension. (c.) It is at least as likely as not that the diabetes is aggravated by the Veteran’s service-connected hypertension. If aggravation is found, identify the baseline level of disability prior to aggravation to the extent possible. The examiner should provide a complete rationale for any opinion set forth. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lopez, Law Clerk