Citation Nr: 20000044 Decision Date: 01/02/20 Archive Date: 01/02/20 DOCKET NO. 17-28 653 DATE: January 2, 2020 ORDER Service connection for a pelvic bone disability is granted. REMANDED The issue of service connection for a sleep disability is remanded. FINDING OF FACT The Veteran’s pelvic bone disability is caused by or related to service. CONCLUSION OF LAW The criteria for service connection for a pelvic bone disability have been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Marine Corps from February 1975 to February 1979. These matters come before the Board of Veterans’ Appeals (Board) from an August 2016 rating decision. The Veteran testified before the Board at a hearing in September 2019. A transcript of the hearing has been associated with the claims file. Service Connection The Veteran asserts that his pelvic bone disability is caused by or related to service. Specifically, he contends that a needle broke and became lodged in his pelvic bone area when an injection was administered during in-service medical treatment. Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Generally, the evidence must show the existence of (1) a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Certain chronic diseases are subject to presumptive service connection if the disease manifests to a compensable degree within one year of separation from service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by affirmative evidence to the contrary. 38 U.S.C. §§ 1112, 1113, 1137; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). Moreover, for such chronic diseases, an alternative method of establishing the second and third Shedden element is through a demonstration of continuity of symptomatology if the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2014). Additionally, evidence of continuous symptoms since active duty is a factor for consideration as to whether a causal relationship exists between an in-service injury or incident and the current disorder as is contemplated under 38 C.F.R. § 3.303(a). The Board has reviewed the evidence of record and finds that service connection is warranted for the Veteran’s pelvic bone disability. First, in September 2019 the Veteran provided credible testimony at a hearing before the Board. The Veteran stated that during service he was involved in an auto accident and required emergency medical treatment. He further stated that during the course of emergency medical treatment, a needle broke during an injection in his pelvic area, became lodged, and has never been removed. He also described the residual symptoms of pain and discomfort from the needle lodged in his pelvic area, which he stated has caused flare ups over the past 40 years. The Board finds that the Veteran’s credible testimony supports a finding of an in-service injury to the pelvic bone area. Next, the Board reviewed the Veteran’s service treatment records (STRs) and found an indication of the incurrence of a pelvic bone disability during service. During the Veteran’s October 1974 entrance examination and January 1979 separation examination, there are no indications of a pelvic bone disability; however, the October 1977 STRs indicate that the Veteran was involved in an auto accident and the February 1978 STRs document a report of pain along the pubic bone area. The Board finds that the evidence in the STRs corroborates the Veteran’s credible hearing testimony regarding an auto accident that occurred during service and regarding pain in the pelvic bone area that started approximately 40 years earlier. Further, the Veteran’s VA treatment records indicate a longstanding history of complaints of pain in the pelvic area. In September 2015, the Veteran reported a history of pain in the pelvic area as a result of a needle breaking when an injection was administered in 1977 during service. Further, the February 2016 VA treatment records note x-rays that document a linear and wire-like density over the pelvic bone, which could correspond to the retained needle clinically reported. In April 2016, May 2017, June 2017, and August 2017, the Veteran continued to report pain and discomfort in his pelvic bone area, which he attributed to the broken needle which became lodged in his pelvic bone area when an injection was administered during service. The Board finds that the evidence in the VA treatment records demonstrates that the Veteran has credibly and consistently reported longstanding and chronic pelvic area pain, which he attributes to a broken needle lodged in his pelvic bone area when an injection was administered during service. Further, this evidence again corroborates the Veteran’s credible hearing testimony regarding the incurrence of a pelvic bone disability during service. Next, in October 2019 the Veteran submitted a statement from his private physician regarding his pelvic bone disability. The physician noted a history of a broken needle lodged in the Veteran’s pelvic bone area since service. The physician also noted a history of chronic pain in the pelvic bone area, which progressively worsened over the years. The physician noted that the imaging studies confirm a foreign body in the pelvic bone area. The physician further noted that the foreign body in the pelvic bone caused pain in the right hip area due to irritation of the tissue and nerves. The physician opined that it was more likely than not that the Veteran’s pelvic bone disability is caused by or related to service. The Board finds the conclusions of the Veteran’s private physician to be of highly probative value. Specifically, the physician found that the imagine studies confirm a foreign body in the pelvic bone area. The physician noted the history of an in-service injury causing a broken needle to be lodged in the Veteran’ pelvic bone area, and the physician concluded that it is more likely than not that the Veteran’s pelvic bone disability was caused by or related to service. The Board finds that this evidence establishes a nexus relationship between the Veteran’s in-services pelvic bone injury caused by a broken needle and the Veteran’s present pelvic bone disability. Resolving any remaining reasonable doubt in the Veteran’s favor, the Board finds that the requirements for establishing service connection for a pelvic bone disability are met. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Therefore, the appeal is granted. REASONS FOR REMAND Sleep Disability The Board finds that further development is necessary regarding the Veteran’s claim for a sleep disability. The Veteran provided credible hearing testimony at the September 2019 hearing before the Board regarding his sleep disability. The Veteran stated that his sleep disability first started during service when he began to experience tinnitus symptoms from noise exposure. The Veteran stated that his sleep disability has continued consistently since discharge from service; however, the Veteran stated that he did not understand that he should file a separate claim for his sleep disability as he thought it would be considered attributed to his service-connected acquired psychiatric disorder. The Veteran stated that he has since received a diagnosis of insomnia, which is separate from his service-connected acquired psychiatric disorder. Next, the Board notes that the August 1978 STRs indicate a history of insomnia and in the January 1979 STRs the Veteran reported sleep difficulties. Further, the VA treatment records first indicate sleep difficulties in April 2011 and demonstrate continued complaints of sleep difficulties to the present. Moreover, the September 2015 VA treatment records indicate a diagnosis of insomnia, which is a separate diagnosis from the Veteran’s service-connected acquired psychiatric disorder. The Board finds that the evidence of record indicates that the Veteran reported in-service sleep difficulties may be related to his diagnosed sleep disability. Thus, the low threshold for obtaining a VA examination has been met in this case. A remand is therefore necessary at this time. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Obtain all treatment records from any VA facility from which the Veteran has received treatment. If the Veteran has received additional private treatment, he should be afforded an appropriate opportunity to submit the medical records of such treatment. 2. Following the completion of the above, schedule the Veteran for an examination to determine the nature and etiology of his sleep disability. The claims folder must be made available to and be reviewed by the examiner. The examiner should address the following: a. Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep disability is caused by or related to service? The examiner should consider the evidence regarding a sleep disability in the STRs, VA treatment records, and the Veteran’s lay hearing testimony. The examiner should also consider all lay statements submitted by the Veteran regarding his disorder. A rationale for all opinions is to be provided. If the examiner cannot provide any of the requested opinions without resorting to speculation, he or she should provide an explanation stating why this is so. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Page-Nelson, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.