Citation Nr: 21001783 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 09-09 201 DATE: January 11, 2021 REMANDED Entitlement to service connection for a back condition, to include as secondary to service-connected migraine headaches, is remanded. Entitlement to service connection for a bilateral knee condition, to include as secondary to service-connected migraine headaches, is remanded. Entitlement to service connection for a sinus condition, to include as secondary to chemical and environmental exposures, is remanded. Entitlement to service connection for a lung condition, to include as secondary to service-connected migraine headaches, and/or secondary to chemical exposures and environmental exposures, is remanded. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected migraine headaches, and/or secondary to chemical exposures and environmental exposures, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1982 to April 1987. He also served in the United States Army Reserve from April 1987 to December 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2007 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. The Board issued a prior remand on these issues in June 2017. 1. Entitlement to service connection for a back condition, to include as secondary to service-connected migraine headaches, is remanded. 2. Entitlement to service connection for a bilateral knee condition, to include as secondary to service-connected migraine headaches, is remanded. 3. Entitlement to service connection for a sinus condition, to include as secondary to chemical and environmental exposures, is remanded. 4. Entitlement to service connection for a lung condition, to include as secondary to service-connected migraine headaches, and/or secondary to chemical exposures and environmental exposures, is remanded. 5. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected migraine headaches, and/or secondary to chemical exposures and environmental exposures, is remanded. As noted above, the Board issued a prior remand on these claims in June 2017, requesting that the record be updated to include all of the Veteran’s Army Reserve records, to obtain verification regarding the Veteran’s claimed chemical and environmental exposures, and to provide the Veteran with new VA examinations for each conditions. The Board regrets that another remand is warranted, however, as the RO did not complete the previously requested remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding remand by the Board confers on the claimant the right to compliance with the remand requests). Specifically, the Board instructed the RO to ask the Veteran to list all claimed chemical and environmental exposures, including the dates and circumstances of such exposures, then to request verification of all claimed exposures from the appropriate military authorities. The Board notes that the Veteran was sent a letter dated October 31, 2017 where a request for the list of such exposures was made. However, a review of the record shows that this letter was sent back to VA as returned mail in December 2017. The Board notes no further efforts by the RO to obtain this information. Nor was any verification of any of the claimed exposure incidents previously noted by the Veteran undertaken. Additionally, the Board instructed the RO to obtain additional VA examinations for each of the Veteran’s claimed conditions, finding prior examinations to be inadequate or failing to provide an appropriate nexus opinion. The Board notes that the Veteran was only given additional VA examinations for his lung condition and sleep apnea. Nevertheless, the opinions provided did not address secondary service connection, nor did they address each of the Veteran’s claimed chemical and environmental exposures. Thus, the Board finds these opinions to be inadequate. As the Veteran was never given another examination for his back, bilateral knees, or sinus conditions, and the lung and sleep apnea opinions are inadequate, another remand is warranted. The matters are REMANDED for the following action: 1. Contact the Veteran and ask that he list all claimed chemical and environmental exposures, including the dates and circumstances of such exposures. 2. Request verification of all claimed chemical and environmental exposures from the appropriate military authorities, including those listed by the Veteran on a Statement in Support of Claim received into the electronic file on August 3, 2007. 3. Update the electronic file with any new VA treatment records and private treatment records. 4. After all the development has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of any current back condition. A copy of the Veteran’s entire claim file should be provided to the examiner and a note that such was reviewed should be included in the report. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current back condition is casually or etiologically related to his active service? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s back condition was caused or aggravated by his service-connected migraine headaches? In formulating an opinion, the examiner should specifically consider and address the Veteran’s back condition reported during basic training and the Veteran’s lay statements regarding his back condition. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. After all the development has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of any current bilateral knee condition. A copy of the Veteran’s entire claim file should be provided to the examiner and a note that such was reviewed should be included in the report. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current bilateral knee condition is casually or etiologically related to his active service? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current bilateral knee condition was caused or aggravated by his service-connected migraine headaches? In formulating an opinion, the examiner should specifically consider and address the Veteran’s lay statements that his bilateral knee pain is related to intensive physical training during service. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 6. After all the development has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of any current sinus condition. A copy of the Veteran’s entire claim file should be provided to the examiner and a note that such was reviewed should be included in the report. The examiner should answer the following question: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current sinus condition is casually or etiologically related to his active service, including any verified chemical or environmental exposures? In formulating an opinion, the examiner should specifically consider and address the August 2005 CT scan indicating that the Veteran had chronic sinus disease, the numerous reports of sinus disease in the Veteran’s service treatment records, the August 2007 VA treatment note that the Veteran has been recently diagnosed with sinusitis by a private physician, and the Veteran’s lay statement that his chronic sinus problems began while he was stationed at Fort Dix and became worse after his “assignment to West Germany and events at Fort Bragg, NC.” A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 7. After all the development has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of any current lung condition. A copy of the Veteran’s entire claim file should be provided to the examiner and a note that such was reviewed should be included in the report. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current lung condition is casually or etiologically related to his active service, including any verified chemical or environmental exposures? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current lung condition was caused or aggravated by his service-connected migraine headaches? In formulating an opinion, the examiner should specifically consider and address the Veteran’s diagnosed restrictive lung disease and his lay statements concerning chemical and environmental exposures during service. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 8. After all the development has been completed, schedule the Veteran for a VA examination to determine the nature and etiology of his obstructive sleep apnea. A copy of the Veteran’s entire claim file should be provided to the examiner and a note that such was reviewed should be included in the report. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current obstructive sleep apnea is casually or etiologically related to his active service, including any verified chemical or environmental exposures? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current obstructive sleep apnea was caused or aggravated by his service-connected migraine headaches? In formulating an opinion, the examiner should specifically consider and address the Veteran’s lay statements that from 1985 to present he woke up with a very sore or dry throat, had loud snoring during sleep, occasionally woke up choking or with a gasping sensation, experienced sleepiness and lack of energy during the work day and while driving, and experienced migraine headaches, insomnia, forgetfulness, mood changes, and decreased interest in sex. A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Ruiz, 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.