Citation Nr: 21000910 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 17-40 851 DATE: January 6, 2021 REMANDED Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served in the Army from November 1964 to October 1967 and is a Veteran of the Vietnam era. This matter comes before the Board of Veteran’s Appeals (Board) from decisions of a Department of Veteran’s Affairs (VA) Regional Office (RO). The service connection claims for sleep apnea and tinnitus were denied in a rating decision dated February 2017. The Veteran participated in a video hearing and testified before the Board of Veteran’s Appeals (Board) in November 2020. A transcript of the hearing is of record. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for sleep apnea is remanded. The Veteran contends that his military occupational specialty (MOS) required him to work in close contact with radio communications and generators to power the devices. The Veteran believes that his tinnitus began in service as a consequence of noise exposure emitted from the communication equipment and the generators. He further believes that his sleep apnea originated in service in two ways: first as an outgrowth of the erratic schedule he was required to keep and further due to the claimed tinnitus condition contributing to and/or causing the sleep apnea condition. In August 2017 the Veteran submitted a statement to the claims file containing factual contentions with regard to both the tinnitus and the sleep apnea conditions. In this statement, the Veteran provided multiple references and quotations from various publications in order to support his contentions with regard to both his tinnitus and his sleep apnea disabilities. A VA medical examination is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). It is VA’ s duty to assess the current state of medical knowledge on the subject, including the articles submitted by the Veteran. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010) (examiner may have duty to conduct research in the medical literature before rendering an inconclusive opinion). The Veteran has submitted articles in his August 2017 statement. The examiners should review the Veterans factual contentions as well as the evidence the Veteran sites from publications. The Veteran has associated additional factual and publication evidence with the file that was not thoroughly discussed by the other examiners. The Board finds that VA medical examinations and opinions with regard to the Veterans claimed tinnitus and sleep apnea are required so the Board can evaluate the Veteran’s contentions. The Board notes it is prohibited from relying on its own unsubstantiated medical judgment in the resolution of a claim. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). Therefore, a remand is necessary to afford the Veteran an additional VA examination to assist in evaluating the Veteran’s claims. The matters are REMANDED for the following action: 1. Afford the Veteran VA examinations with appropriate specialist(s) to conduct examinations for each of the two disabilities and determine the nature and etiology of his tinnitus and sleep apnea. This remand and the entire claims file should be made available, reviewed by the examiner(s), and the examiner(s) should note this was accomplished. The examiner(s) are requested to review the factual allegations and publication materials set forth in the Veteran’s August 2017 statement, service treatment records, post-service medical records, and any other pertinent records associated with the claims file. The examiner is encouraged to assess the current state of medical knowledge on the subject. Any indicated tests and studies should be undertaken and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. For tinnitus, opine whether it is at least as likely as not that the tinnitus was caused by, aggravated by, manifested during, or was otherwise etiologically related to his military service, to include claimed exposure to radio and generator noise. For sleep apnea, opine whether it is at least as likely as not that the sleep apnea was caused by, aggravated by, manifested during, or was otherwise etiologically related to his military service, to include causation claimed due to the erratic sleep schedule required during military service; and to include causation claimed due to claimed tinnitus. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a certain conclusion as it is to find against it. It should be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A clear explanation for all opinions based on specific facts of the case as well as relevant medical principles is needed. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.M. Schneider 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.