Citation Nr: 18158740 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 16-55 884 DATE: December 18, 2018 REMANDED Entitlement to service connection for fibromyalgia due to exposure to environmental hazards in Southwest Asia is remanded. Entitlement to service connection for shortness of breath due to exposure to environmental hazards in Southwest Asia is remanded. Entitlement to service connection for sleep apnea (previously claimed as sleep problems) due to exposure to environmental hazards in Southwest Asia is remanded. Entitlement to service connection for gastroesophageal reflux disease (GERD) due to exposure to environmental hazards in Southwest Asia is remanded. Entitlement to service connection for migraine headaches due to exposure to environmental hazards in Southwest Asia is remanded. Entitlement to a compensable evaluation for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1972 to August 1975 and from August 1975 to February 1996. This matter comes to the Board of Veterans’ Appeals (Board) from January 2015, August 2015, and October 2016 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for fibromyalgia due to exposure to environmental hazards in Southwest Asia is remanded. The Veteran claims service connection for fibromyalgia due to exposure to environmental hazards in Southwest Asia. The Veteran had service in Southwest Asia. The Veteran attended a VA examination in November 2014. The November 2014 VA examiner noted that the Veteran did not meet the criteria to have a current diagnosis for fibromyalgia as his symptoms were well accounted for by other diseases. However, the November 2014 VA examiner noted that the Veteran had been seeking treatment from one outside doctor, Dr. K., for more than nine years, but only one clinic note from 2009 was associated with the claims file. The Veteran also reported that he underwent cervical spine fusions in 1999 and 2002, and reinjured his neck in 2013 at work and had physical treatment for his neck until March 2014. There are no records of the cervical spine fusions or the 2013 neck injury or subsequent treatment associated with the claims file. Finally, VA treatment records associated with the claims file indicate that the Veteran has sought VA treatment as recent as January 2017. As the Veteran may have received treatment from VA more recently than January 2017, on remand, the RO should obtain and associate with the claims file any VA treatment records not already associated with the claims file. As there are outstanding records of treatment received by the Veteran, a remand is required before this issue can be adjudicated.   2. Entitlement to service connection for shortness of breath due to exposure to environmental hazards in Southwest Asia. is remanded. The Veteran claims service connection for shortness of breath due to exposure to environmental hazards in Southwest Asia. The Veteran attended a VA examination in November 2014. The November 2014 VA examiner noted that there was insufficient evidence of any current lung disease and that the Veteran’s shortness of breath is less likely than not related to an unknown illness as the symptoms are most likely functional. As discussed above, there are outstanding medical records that are not yet associated with the claims file. As there are outstanding records of treatment received by the Veteran, a remand is required before this issue can be adjudicated. 3. Entitlement to service connection for sleep apnea due to exposure to environmental hazards in Southwest Asia is remanded. The Veteran claims service connection for shortness of breath due to exposure to environmental hazards in Southwest Asia. The Veteran attended a VA examination in July 2015. The July 2015 VA examiner noted that there was insufficient evidence to warrant a diagnosis of sleep apnea. The Veteran told the VA examiner that he started having trouble maintaining sleep around 1994 and in 1999 after a surgical procedure, the Veteran was told by a doctor that the doctor thought he had sleep apnea. As discussed above, there are outstanding medical records that are not yet associated with the claims file. As there are outstanding records of treatment received by the Veteran, a remand is required before this issue can be adjudicated. 4. Entitlement to service connection for GERD due to exposure to environmental hazards in Southwest Asia is remanded. The Veteran claims service connection for shortness of breath due to exposure to environmental hazards in Southwest Asia. The Veteran attended a VA examination in November 2014. The November 2014 VA examiner noted that, while the Veteran had a diagnosis for GERD, it is less likely than not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The Veteran reported being treated for GERD by outside doctors, and being hospitalized for GERD at Penrose Hospital in Colorado Springs, CO, in June 2012. The Veteran also reported undergoing panendoscopies in August 2012 and September 2013. Records of the Veteran’s treatment have not been associated with the claims file. As there are outstanding records of treatment received by the Veteran, a remand is required before this issue can be adjudicated. 5. Entitlement to service connection for migraine headaches due to exposure to environmental hazards in Southwest Asia is remanded. The Veteran claims service connection for shortness of breath due to exposure to environmental hazards in Southwest Asia. The Veteran attended a VA examination in November 2014. The November 2014 VA examiner noted that, while the Veteran had a diagnosis for migraine headaches, the Veteran’s migraine headaches are less likely than not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The Veteran reported to the VA examiner that his migraine headaches are triggered by red wine and chocolate. The Veteran reported being treated for migraines by private doctors, to include Dr. C. Records of the Veteran’s treatment have not been associated with the claims file. As there are outstanding records of treatment received by the Veteran, a remand is required before this issue can be adjudicated. 6. Entitlement to a compensable evaluation for bilateral hearing loss is remanded. The Veteran is service connected for bilateral hearing loss at a noncompensable rating. The Veteran last underwent a VA examination for his service-connected hearing loss in August 2016. The Veteran contends that his hearing loss has gotten worse since the August 2016 VA examination. When it is indicated that the severity of a service-connected disability has increased since the most recent rating examination, an additional examination is appropriate. See Caffrey v. Brown, 6 Vet. App. 377 (1995); Green v. Derwinski, 1 Vet. App. 121 (1991). As the Veteran’s complaints indicate possible worsening of the service-connected condition, the Veteran should be afforded a more contemporaneous VA examination to address the severity of this condition. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from January 2017 to the present and associate those records with the claims file. 2. Ask the Veteran to complete a VA Form 21-4142 for each physician or facility where he sought treatment for each of his claimed service-connected disabilities, to include Dr. K, Dr. C, and Penrose Hospital in Colorado Springs, CO. Make two requests for the authorized records from each physician or facility identified by the Veteran, unless it is clear after the first request that a second request would be futile. 3. Take the necessary steps to request records related to any claim for workers’ compensation or personal injury claimed by the Veteran, to include the reported 2013 neck injury and subsequent treatment. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed fibromyalgia. If fibromyalgia is diagnosed, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including service in Southwest Asia. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any breathing disability. If any breathing disability is diagnosed, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including service in Southwest Asia. 6. Schedule the Veteran for an examination by an appropriate clinician to determine whether the Veteran suffers from sleep apnea. If sleep apnea is diagnosed, the examiner should opine on the nature and etiology of the sleep apnea. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including service in Southwest Asia. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s previously diagnosed GERD. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including service in Southwest Asia. 8. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any migraine headache disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including service in Southwest Asia. 9. Schedule the Veteran for an examination by an appropriate clinician to determine the current nature of any recurrent joint, muscle, and fatigue disabilities and their relationship, if any, to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all recurrent joint, muscle, and fatigue disabilities found. (b) State whether any identified joint, muscle, and fatigue disability is consistent with a clinically known diagnosis or is due to either an undiagnosed illness or a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome) that is defined by a cluster of signs or symptoms. (Continued on the next page)   (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified recurrent joint, muscle, and fatigue disability had its onset during active service or is related to any incident of service, including the Veteran’s service in Southwest Asia. 10. Schedule the Veteran for an audiological examination to determine the current nature and severity of his bilateral hearing loss. All appropriate testing, to include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test, should be conducted. The examiner should also comment on the functional effects caused by any hearing loss. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Boal, Associate Counsel