Citation Nr: 18159222 Decision Date: 12/19/18 Archive Date: 12/18/18 DOCKET NO. 11-18 653 DATE: December 19, 2018 REMANDED Entitlement to service connection for a sciatic nerve disability is remanded. Entitlement to service connection for a sleep apnea disability is remanded. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to November 1971 including service in the Republic of Vietnam. During the course of the appeal, the Veteran has claimed entitlement to a TDIU based, in part, on his service-connected PTSD symptoms. See an August 2016 TDIU application form. The issue is part and parcel with the Veteran’s initial rating claim for PTSD, and has been added as an issue on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). 1. Entitlement to service connection for a sciatic nerve disability is remanded. The Veteran claims entitlement to service connection for peripheral neuropathy, to include as secondary to service-connected diabetes mellitus. Although prior peripheral nerve and diabetes VA examinations have not shown the presence of a peripheral neuropathy disability, VA treatment records dated in October 2016 show that the Veteran was given a qualifying diagnosis of peripheral neuropathy with diminished sensation to the bilateral feet. He was measured for prosthetic orthotics for shoes, diabetes socks and diabetic custom inserts. On remand, the Veteran should be afforded an updated peripheral neuropathy examination to confirm the presence of the disability, and to determine its etiology. 2. Entitlement to service connection for a sleep apnea disability is remanded. The Veteran was afforded a VA respiratory examination in November 2010. The examiner noted that the Veteran’s diagnosed obstructive sleep apnea disability was less likely than not proximately due to or the result of the Veteran’s service connected diabetes condition. The examiner noted that sleep apnea is caused by laxity of the upper airway and tongue laxity while asleep and that diabetes does not cause these types of physical changes. The examiner did not address whether the Veteran’s service connected diabetes aggravated his obstructive sleep apnea disability beyond its natural progression. An opinion that something “is not related to” or “is not due to” does not answer the question of aggravation. Allen, 7 Vet. App. at 448. Given that the medical evidence of record fails to adequately address the issue raised, the Board finds that a new examination is necessary. 3. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD), and a TDIU. The Veteran’s PTSD was last examined by VA in June 2015. The Veteran has since asserted that he gets numerous panic attacks a week, is forgetful in completing tasks, and that he left his job because of this condition. See the Veteran’s July 2015 notice of disagreement; see also the November 2016 statement of his wife (indicating panic attacks panic attacks twice a week and short-term memory loss). On his November 2016 VA Form 9, the Veteran stated he told his primary care nurse and the Behavior Health Department about his panic attacks, and asserted that VA is not annotating these complaints in his progress notes. Given these assertions of worsened symptoms, on remand, the Veteran should be afforded an updated PTSD examination to assess the severity of his service-connected PTSD. In addition, although some VA treatment records pertaining to other disabilities dating through October 2016 are of record, no records of mental health treatment exist dated since his June 2015 VA examination. In light of the Veteran’s comments on his VA Form 9, all records of VA treatment dated since June 2015 should be associated with the Veteran’s claims file. Finally, as the question of entitlement to a TDIU is intertwined with the outcome of each of the issues remanded herein, the Board will defer adjudication of this issue. The matter is REMANDED for the following action: 1. Send a letter to the Veteran requesting that he submit, or authorize VA to obtain on his behalf, any records of private care for the disabilities at issue. Upon submission of appropriate authorization, obtain such records. 2. Associate with the Veteran’s file all records of VA treatment dated from June 2015 to the present day. 3. Schedule the Veteran for a VA nerves examination to clarify whether the Veteran has a peripheral neuropathy disability, and if so whether it is related to service or a service-connected disability. The entire claims file must be made available to, and reviewed by the examiner. All appropriate tests and studies should be accomplished and all clinical findings should be reported in detail. Following a review of the entire record, to include the Veteran’s lay statements concerning onset and continuity of symptomatology, the examiner should address the following inquiries: a) Please clarify whether the Veteran suffers from peripheral neuropathy of the extremities. b) If so, is it at least as likely as not (a 50 percent or higher probability) that such disability had onset in, or is otherwise related to the Veteran’s period of service, to include in-service exposure to herbicide agents? c) Notwithstanding the above, is it at least as likely as not that such disability was caused or aggravated beyond its natural progression by his service-connected diabetes mellitus? The Board emphasizes that causation and aggravation are two separate inquiries, and both must be answered. A complete rationale must be provided for all opinions provided. 4. The Veteran should be afforded a new VA examination to determine whether his current sleep apnea disability is related to his military service and/or secondary to his service-connected disabilities. The record must be made available to and reviewed by the VA examiner. Any indicated evaluations, studies, and tests should be conducted. Following a review of the entire record, the examiner should address the following questions: a) Is it at least as likely as not (i.e., a 50 percent or greater probability) that a sleep apnea disability had its onset in, or is otherwise related to his period of active duty service? b) Notwithstanding the above, is it at least as likely as not (i.e., a 50 percent or greater probability) that a sleep apnea disability was caused or aggravated beyond its natural progression by any service-connected disability, individually or in combination, to include PTSD and/or diabetes mellitus? In this regard, the Board emphasizes that causation and aggravation are two separate inquiries, and both must be answered. A complete rationale must be provided for all opinions provided. 4. Schedule the Veteran for an updated PTSD examination to assess the current severity of his disability. The examiner should specifically discuss the extent to which the Veteran’s PTSD impacts his ability to work. (Continued on Next Page) 5. Readjudicate the appeal. If the benefits sought remain denied, issue the Veteran and his representative a Supplemental Statement of the Case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD David M. Sebstead, Associate Counsel