Citation Nr: 18159719 Decision Date: 12/19/18 Archive Date: 12/19/18 DOCKET NO. 16-57 283 DATE: December 19, 2018 ORDER New and material evidence has been received and the claim for service connection for sleep apnea is reopened. Service connection for sleep apnea is granted. New and material evidence has been received and the claim for service connection for hypertension is reopened. Service connection for hypertension is granted. REMANDED Service connection for headaches is remanded. A compensable disability rating for fracture, left fourth metacarpal is remanded. FINDINGS OF FACT 1. By a September 2007 rating decision, the RO denied service connection for sleep apnea; the Veteran was advised of the RO’s decision and of his appellate rights but did not timely initiate an appeal or submit new and material evidence. 2. The evidence received since the September 2007 rating decision (including the August 2017 medical opinion by Dr. H.S.), by itself or in conjunction with previously considered evidence, relates to an unestablished fact necessary to substantiate the claims for service connection for sleep apnea. 3. The Veteran has a current diagnosis of sleep apnea. See August 2017 Disability Benefits Questionnaire. 4. An August 2017 private opinion by Dr. H.S. stated that upon speaking with the Veteran and reviewing his claim file, his sleep apnea more likely than not began in service and was caused or permanently aggravated by his psychiatric condition. Dr. H.S. noted August and September 1973 service records which stated the Veteran fell asleep frequently and was found sleeping through many of his classes, as well as his September 1973 separation examination which reported sleeping trouble and nervous trouble. Dr. H.S. also cited to three lay statements from the Veteran’s family members noting that his sleep problems began in service. Dr. H.S. further noted a May 2016 psychiatric treatment note stating the Veteran had chronic sleep impairment with insomnia and broken sleep. Finally, he cited to a journal article which found patients with psychiatric issues are five times more likely develop sleep apnea. 5. By an April 1978 rating decision, the RO denied service connection for hypertension; the Veteran was advised of the RO’s decision and of his appellate rights but did not timely initiate an appeal or submit new and material evidence. 6. The evidence received since the April 1978 rating decision (including July 1996 medical records showing treatment shortly after service and increased risk for African American males), by itself or in conjunction with previously considered evidence, relates to an unestablished fact necessary to substantiate the claims for service connection for hypertension. 7. The Veteran has a current diagnosis of hypertension. See July 1996, August 2012 treatment records. 8. The Veteran’s September 1973 separation examination noted asymptomatic hypertension last treated while in service in 1971. 9. The Veteran’s hypertension began in service and has continued since service. CONCLUSIONS OF LAW 1. The criteria for service connection for sleep apnea have been met. 38 U.S.C. §§ 1110, 5107 (2012); §§ 38 C.F.R. 3.102, 3.303 (2017). 2. The criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107 (2012); §§ 38 C.F.R. 3.102, 3.303 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1971 to October 1973. For the reasons outlined above, service connection for sleep apnea and hypertension is warranted. REASONS FOR REMAND 1. Service connection for headaches is remanded. The Veteran reported headaches and migraines several times while in service. See service treatment records (STRs) dated in May 1972, September 1972, and April 1973. His post-service treatment records note various reports and diagnoses of sinus headaches and other headaches. See treatment records dated in June 2013, July 2016, August 2016, and February 2017. February 2017 records also note a November 2014 head CT but the results do not appear to be of record. These records must be obtained, as well as an examination to determine the nature and cause of any headache disability. 2. A compensable disability rating for fracture, left fourth metacarpal is remanded. The Veteran has reported finger numbness and tingling several times. See January 2000 and December 2014. He was last afforded a VA examination in April 2013. A new examination must be obtained to determine the current nature and severity of his symptoms. The matters are REMANDED for the following action: 1. Obtain the results of the November 3, 2014 head CT noted in the February 2017 treatment records. 2. After completing step 1, schedule the Veteran for a VA examination with an appropriate specialist to determine the nature and cause of any headache disability. The entire record must be reviewed by the examiner in conjunction with the examination, and all diagnostic tests or studies deemed necessary must be completed. Based on this review and examination of the Veteran, the examiner should provide responses to the following: (a.) Identify any headache disability. (b.) Is it at least as likely as not (50 percent or greater probability) that any headache disability began in, or was caused by or otherwise related to active military service or events therein? The examiner must address the Veteran’s reports of headaches in service. (See STRs dated in May 1972, September 1972, and April 1973). 3. Schedule the Veteran for a VA examination with an appropriate specialist to determine the current severity of his left fourth metacarpal disability. The examiner must address the Veteran’s reports of tingling and numbness. (See treatment records dated in January 2000 and December 2014) A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. D’Allaird, Associate Counsel