Citation Nr: 21061786 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-39 260 DATE: October 5, 2021 REMANDED Service connection for sleep apnea is remanded. Service connection for fibromyalgia is remanded. Service connection for a gastrointestinal disorder, to include irritable bowel syndrome, other than status post Mallory Weiss esophageal tear with GERD, is remanded. Service connection for a heart disorder is remanded. Service connection for chronic fatigue syndrome is remanded. REASONS FOR REMAND The Veteran has active service from September 1967 to September 1970 and June 1991 to January 1992, including service in Saudi Arabia and Kuwait. This matter is on appeal from a March 2013 rating decision that denied the Veteran's claims of service connection, which he filed in December 2011. In December 2019, the Veteran withdrew his request for a hearing. 1. Service connection for sleep apnea is remanded. A medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (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 disability for which service connection was awarded, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 8186 (2006). See also 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). These elements are satisfied with regard to the claim of entitlement to service connection for sleep apnea. Regarding the first element, a September 2015 VA medical record indicates the Veteran "being seen in Walk-In Clinic for management of obstructive sleep apnea." Regarding the second element, in his December 2011 claim, the Veteran argues that his sleep disturbances are a result of his service in the Persian Gulf. Regarding the third and fourth elements, there is an indication that sleep problems could be related to Gulf War service, but there is insufficient evidence of record by which the Board can make a decision. As the four McLendon elements are satisfied, the Veteran is entitled to a VA examination and medical opinion. 2. Service connection for fibromyalgia is remanded. The January 2017 VA hand and knee examinations indicate diagnoses of right hand arthritis and right knee osteoarthritis. In his January 2017 VA fibromyalgia and Gulf War examinations the Veteran describes pain in the hands, fingers, knees, and toes. In a May 2018 VA medical record, the Veteran indicates "nerve pain in both [feet]" that "feels like pins sticking in them." In light of the May 2018 description of nerve pain, the Board finds that another VA examination is necessary to adjudicate this appeal. Green v. Derwinski, 1 Vet. App. 121 (1991). 3. Service connection for a gastrointestinal disorder, to include irritable bowel syndrome, other than status post Mallory Weiss esophageal tear with GERD, is remanded. The RO has denied service connection for irritable bowel syndrome claim on the basis that there was no diagnosis of a current disorder. In light of the Veteran's complaints, the Board finds that another VA gastrointestinal examination is necessary to adjudicate this appeal. 4. Service connection for a heart disorder is remanded. 5. Service connection for chronic fatigue syndrome is remanded. The Veteran's heart and chronic fatigue claims are inextricably intertwined with the claims remanded for further development. Accordingly, they must be considered together, and thus a decision by the Board on these claims would at this point be premature. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). Additionally, on remand the RO should obtain all relevant VA treatment records dated from August 2018 to the present before the issues on appeal are decided on the merits. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain all VA treatment records from August 2018 to the present. If no records are available, the claims folder must indicate this fact. Any additional records identified by the Veteran during the course of the remand should also be obtained, following the receipt of any necessary authorizations from the Veteran, and associated with the claims file. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge any in-service and post-service chronic fatigue, fibromyalgia, heart disorder, irritable bowel syndrome and sleep apnea problems. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the nature, onset and etiology of his claimed sleep apnea, fibromyalgia, heart disorder, chronic fatigue disorder, and gastrointestinal disorder (to include irritable bowel syndrome) other than status post Mallory Weiss esophageal tear with GERD. Based on the results of the examination, the examiner is asked to address each of the following questions: (a.) Diagnoses of irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome must be ruled in or excluded. (b.) Please state whether the symptoms of each claimed condition are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (c.) Is the Veteran's disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, (2) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis? In addressing fibromyalgia, the examiner should consider the Veteran's reports of knee pain, hand pain, and nerve pain in the feet. (d.) If, after examining the Veteran and reviewing the claims file, it is determined that the Veteran's disability pattern is either (1) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (2) a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to a presumed environmental exposures experienced by the Veteran during service in Southwest Asia. (e.) Is it at least as likely as not that any diagnosed disorder had its onset directly during the Veteran's service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (f.) If not directly related to service on the basis of questions (b)-(d), is any medical condition proximately due to, the result of, or caused by any disability(ies) for which service connection has been awarded? (Continued on the next page) (g.) If not caused by another medical condition, has any disorder been aggravated by any disability(ies) for which service connection has been awarded? STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Cannon, Brian 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.