Citation Nr: 21062827 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 15-32 610 DATE: October 12, 2021 ORDER Entitlement to service connection for primary hypersomnia is granted. REMANDED Issue of entitlement to a rating higher than 20 percent for left shoulder tendonitis and degenerative arthritis is remanded. Issue of entitlement to a rating higher than 20 percent for right shoulder tendonitis and degenerative arthritis is remanded. FINDING OF FACT The evidence supports that the Veteran's primary hypersomnia was incurred during service. CONCLUSION OF LAW The criteria for entitlement to service connection for primary hypersomnia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1983 to May 1998, September 2005 to July 2007, May 2009 to October 2011. This appeal to the Board of Veterans' Appeals (Board) arose from merged appeals of the March 2012 and December 2012 rating decisions issued by the Department of Veterans Affairs (VA). See April 2012 Notice of Disagreement (NOD); December 2012 NOD; July 2015 Statement of the Case (SOC); August 2015 Substantive Appeal (VA Form 9). In June 2019, the Board remanded the Veteran's claims of entitlement to ratings higher than 20 percent for his left and right shoulder tendonitis and degenerative arthritis for further development. June 2019 Board Decision. The Board remanded the claim of entitlement to service connection for idiopathic hypersomnia without long sleep time for the agency of original jurisdiction (AOJ) to issue an SOC. Id. The AOJ issued a July 2020 SOC for the Veteran's claim of entitlement to service connection for idiopathic hypersomnia without long sleep time. The Veteran then perfect his appeal to the Board. August 2020 VA Form 9. The claim is, thus, now in appellate status before the Board. The Board notes that the Veteran's claim of entitlement to service connection for idiopathic hypersomnia without long sleep time was recharacterized to primary hypersomnia to more accurately reflect the current medical evidence. Entitlement to service connection for primary hypersomnia. The Veteran asserts entitlement to service connection for primary hypersomnia based on having sleep problems during service. See December 2012 NOD. Service connection may be established for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Service connection is established when there is competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The Veteran complained of sleep problems during service and, through a multiple sleep latency test, was diagnosed with physiologic hypersomnia, unspecified. July 2011 Army Medical Center treatment evidence. The Veteran continued to seek treatment after separation and his treatment provider assessed him with primary hypersomnia based on the prior medical treatment evidence and the Veteran's current symptoms. See February 2018 Army Medical Center treatment evidence. Based on the above, the Board finds that the evidence supports that the Veteran has a current disability of primary hypersomnia that was incurred during service. Accordingly, entitlement to service connection for primary hypersomnia is warranted. REASONS FOR REMAND 1. Issue of entitlement to a rating higher than 20 percent for left shoulder tendonitis and degenerative arthritis is remanded. 2. Issue of entitlement to a rating higher than 20 percent for right shoulder tendonitis and degenerative arthritis is remanded. Unfortunately, the Board finds that another remand is needed to obtain clarification from a VA examiner about the Veteran's restrictions during a flare-up. The June 2019 Board decision remanded the claims to afford the Veteran an opportunity for a VA examination that assesses his limitations during a flare-up of his left and right shoulder symptoms. An August 2020 VA examination for shoulder and arm conditions was obtained in which the Veteran reported having flare-ups that caused continuous shoulder pain. The Veteran indicated that his shoulder could not move in any direction due to pain. See id. The VA examiner found the Veteran had right shoulder flexion up to 50 degrees and abduction up to 60 degrees. Id. The exam found left shoulder flexion up to 80 degrees after repetitive use and abduction up to 100 degrees. Id. The examination was not performed during a flare-up, but the examiner estimated that the findings were neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. However, the Board finds that a more detailed explanation is needed. It is unclear how the Veteran's statements about his flare-up symptoms were considered with the examination findings. Clarification from a VA examiner is, thus, needed. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate medical professional to determine the severity of the Veteran's service-connected left and right shoulder disabilities. If possible, obtain the opinion from the same medical professional who performed the August 2020 VA examination for shoulder and arm conditions. The medical professional should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. If the medical professional determines that it is necessary, schedule the Veteran for a VA examination. The medical professional should respond to the following: (a) Clarify the Veteran's left and right shoulder range of motion during a flare-up of his symptoms. During the August 2020 VA examination for shoulder and arm conditions, the Veteran reported having flare-ups that caused continuous pain with restriction in movement in any direction. The August 2020 VA examiner opined that the Veteran had right shoulder flexion up to 50 degrees and abduction up to 60 degrees, and left shoulder flexion up to 80 degrees and abduction up to 100 degrees. The examiner opined that the examination findings were neither medically consistent nor inconsistent with the Veteran's statements but provided no explanation as to why. In other words, it is unclear how the Veteran's statement that he has pain moving his shoulders in any direction during a flare-up is consistent with the examination findings. (b) In providing the requested opinion, consider the Veteran's description of his symptoms during a flare-up. If there is any medical reason to accept or reject the Veteran's reported symptoms, this should be noted. Stated another way, are the Veteran's reports about his symptoms inconsistent with the medical evidence, is generally inconsistent with medical knowledge, or implausible? (Continued on the next page) 2. Readjudicate the claims. R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Lin 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.