Citation Nr: 21005130 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 16-36 580 DATE: January 29, 2021 REMANDED Service connection for a neck disability is remanded. Service connection for a left shoulder disability is remanded. Service connection for a disability of the left upper extremity is remanded. Service connection for a disability of the left lower extremity is remanded. Service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1972 to July 1975 and from May 1986 to July 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision. The Veteran participated in a November 2020 hearing before the undersigned, and a transcript of this hearing has been associated with the record. The Veteran claims that he experiences a neck disability, left shoulder disability, and disabilities of the upper and lower left extremities as the result of an August 1988 motor vehicle accident. The medical record indicates that, since his separation from service, the Veteran has received medical treatment from Tripler Army Medical Center (Tripler). For example, when he was examined in August 2013, reference was made to an April 2009 x-ray examination showed moderate spondylosis of C5-C6 and C6-C7 with no acute osseous injury. The August 2013 examiner similarly noted that the Veteran had been diagnosed with a rotator cuff tear of the left shoulder in 2012. Further, during his November 2020 hearing before the undersigned, the Veteran indicated that he had received medical treatment from both Tripler and VA clinicians. The record does not contain medical treatment records from Tripler or any VA records outside of notes from August 2013. On remand, the Agency of Original Jurisdiction (AOJ) should undertake all appropriate efforts to associate these medical records with the Veteran’s claims file. Additionally, while this case is remanded, the Veteran should be afforded with the opportunity to provide waivers allowing VA to obtain private treatment records, including records addressing his diagnosis with OSA. The matters are REMANDED for the following actions:  1. Solicit waivers from the Veteran authorizing VA to obtain any pertinent private treatment records, and, to the extent the Veteran provides such waivers, undertake all reasonable efforts to obtain such treatment records. 2. Undertake all reasonable efforts to associate pertinent VA treatment records and records from Tripler (including the April 2009 x-ray report and 2012 records treating the Veteran for a left rotator cuff tear) with the Veteran’s claims file. The AOJ should document all efforts that it undertakes to obtain these records, and it should inform the Veteran of the same. 3. To the extent that additional medical records are obtained pursuant to the first two remand directives, then obtain the following opinions from an examiner of appropriate expertise. A physical examination of the Veteran should occur only if the examiner determines that it is required in order to offer the requested opinions. Following a review of the Veteran’s claims file, the examiner should address the following questions: (a.) Has the Veteran experienced a chronic disability of the left upper extremity, the left lower extremity, or OSA at any time since filing his claim in July 2012? If so, then address each of these questions: i. Is it at least as likely as not (that is, a 50 percent or greater probability) that a disability of the left upper extremity, a disability of the left lower extremity, or OSA had its onset during the Veteran’s active service, or is such disability otherwise related to the Veteran’s active service? ii. Is it at least as likely as not that a disability of the left upper extremity, a disability of the left lower extremity, or OSA was caused by service-connected disability? iii. Is it at least as likely as not that a disability of the left upper extremity, a disability of the left lower extremity, or OSA underwent any incremental increase in disability, regardless of its permanence, due to service-connected disability? The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. (b.) Is it at least as likely as not (that is, a 50 percent or greater probability) that the Veteran’s neck disability or left shoulder disability had its onset during the Veteran’s active service, or is such disability otherwise related to the Veteran’s active service? MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.A. Flynn, 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.