Citation Nr: 18160196 Decision Date: 12/27/18 Archive Date: 12/26/18 DOCKET NO. 16 64-003 DATE: December 27, 2018 REMANDED Entitlement to service connection for a back condition, to include as secondary to the service connected right knee condition, is remanded. Entitlement to service connection for neuropathy, to include as secondary to the service connected right knee condition, is remanded. Entitlement to service connection for a sleep condition, to include as secondary to the service connected right knee condition, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from August 1981 to August 1985. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision of the Philadelphia, Pennsylvania, Department of Veterans Affairs (VA) Regional Office (RO). In November 2018 a Board hearing was held before the undersigned in New Orleans, Louisiana. The Board notes that the November 2013 rating decision also denied service connection for chronic obstructive pulmonary disease (COPD). The Veteran properly filed a notice of disagreement, and a Statement of the Case was issued in December 2016. However, the Veteran limited his substantive appeal (VA-9) to entitlement to service connection for a back condition, sleep condition, and neuropathy. As such, that matter is not before the Board. 1. Entitlement to service connection for a back condition, to include as secondary to the service connected right knee condition is remanded. 2. Entitlement to service connection for a sleep condition, to include as secondary to the service connected right knee condition is remanded. 3. Entitlement to service connection for peripheral neuropathy, to include as secondary to the service connected right knee condition is remanded. Service treatment records do not contain any evidence of treatment, complaints or diagnosis of a sleep condition or neuropathy. STRs document a back injury. VAMC treatment records document lumbar levoscoliosis and degenerative disc disease. VAMC records reveal the Veteran has been prescribed sleep medication, and document peripheral neuropathy. The Veteran as reported his back was injured when his right knee gave out sometime in 2011 or 2012. In November 2013 he underwent an examination, and the examiner found the Veteran did not suffer from any back condition. At a June 2016 examination, the Veteran was diagnosed with degenerative arthritis of the spine, and bilateral lower extremity radiculopathy. The examiner noted the Veteran was treated for a low back condition during service in 1984. The examiner concluded the Veteran’s back condition is less likely than not incurred in or caused by service, and is less likely than not proximately due to or the result of the Veteran’s knee condition. The rationale was the back condition did not arise until April 2011. He stated the back injury is secondary to an injury and not to the right knee condition. In November 2016, an addendum was rendered. A review of the file indicated in March 2011, the Veteran was seen for complaints of pain, following an incident when he was pushing a car in the garage and slid to the floor. There is no indication the fall was due to the knee giving out. The etiology of the back injury is a fall or slide to the floor due to disc herniation, sustained while pushing a car. To conclude his back condition is not secondary to the service connected knee condition. As for his sleep condition, the Veteran has consistently reported difficulty sleeping. His VAMC records do not document a diagnosis for a sleep condition, however, he was prescribed sleep medication. He has asserted that he suffers from insomnia because of knee and back pain. The Veteran has asserted he suffers neuropathy secondary to his back and knee disabilities. At the June 2016 examination the examiner concluded the Veteran’s nerve condition is not at least as likely as not due to or the result of the back condition, or due to a service connected condition. An opinion on aggravation was not rendered. The Veteran has asserted that his knee condition aggravated his back condition. There is no opinion of record addressing this contention. The claim must be remanded for an addendum opinion addressing whether the back condition was aggravated by the knee condition, and whether neuropathy was aggravated by the knee condition. He has asserted he suffers from a sleep condition as a result of pain from his right knee condition. He has not been afforded an examination to address his sleep condition. The claim must be remanded for an examination to address the etiology of any sleep condition. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran’s claims file all ongoing treatment records. Appropriate efforts should be made to obtain and associate with the case file any further medical records (private and/or VA) identified and authorized for release by the Veteran. 2. Schedule the Veteran for an appropriate examination for the Veteran’s claimed sleep condition. The claims file should be made available to the examiner. Following a review of the claims file, the reviewing examiner should provide an opinion for the following questions: a) Is it at least as likely as not that a sleep condition was caused OR aggravated (worsened beyond its natural progression) by the service-connected right knee disability? b) If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of the sleep condition, by the service-connected disability. c) If not, is it at least as likely as not that the Veteran’s sleep condition is otherwise related to an event, injury, or disease in active duty? The examiner is asked to address the Veteran’s contentions, and to provide a rationale for all opinions reached. 3. Obtain an addendum opinion regarding the claimed back condition and neuropathy. If the examiner determines that additional examination of the Veteran is necessary to provide a reliable opinion, such examination should be scheduled. The examiner should answer the following questions: a) Is it at least as likely as not that a back condition and neuropathy, was caused OR aggravated (worsened beyond its natural progression) by the service-connected right knee disability? b) If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of the back condition and neuropathy, by the service-connected disability. c) If not, is it at least as likely as not that the Veteran’s back condition and neuropathy is otherwise related to an event, injury, or disease in active duty? The examiner is asked to address the Veteran’s contentions, and to provide a rationale for all opinions reached. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Skiouris, Associate Counsel