Citation Nr: 21062854 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 17-40 491 DATE: October 12, 2021 REMANDED Entitlement to a compensable disability rating for post pilonidal cystectomy, incision, and drainage of perianal abscess is remanded. Entitlement to a compensable disability rating for hemorrhoids is remanded. Entitlement to service connection for sleep apnea, as secondary to the service-connected Chronic Obstructive Pulmonary Disease (COPD) with associated interstitial lung disease (ILD), is remanded. REASONS FOR REMAND The Veteran served in the Marine Corps from December 1970 to April 1971, and the Navy from March 1975 to March 1979, and October 1981 to January 1995. This appeal comes before the Board of Veterans' Affairs (Board) from an October 2015 rating decision by the regional office (RO). In the July 2017 substantive appeal, the Veteran requested a Board hearing. However, in February 2021, the Veteran reported that he no longer wanted a Board hearing, thus, withdrawing his request for a hearing. 38 C.F.R. §§ 20.702 (e), 20.704(e). 1. Status post pilonidal cystectomy, incision, and drainage of perianal abscess 2. Hemorrhoids In a March 2021 correspondence, the Veteran's representative stated that the October 2015 VA examination did not adequately express the Veteran's current state of disability due to the age of the examinations and the current symptoms of the Veteran was experiencing. Accordingly, as the evidence indicates that the Veteran's disabilities may have worsened, remand is required to afford the Veteran a new VA examination. See Caffrey v. Brown, 6 Vet. App. 377 (1994); Snuffer v. Gober, 10 Vet. App. 400 (1997). 3. Sleep apnea The August 2015 VA opinion found that the Veteran's obstructive sleep apnea was less likely than not proximately due to or the result of the service-connected COPD and ILD. The examiner noted that although sleep apnea may be worsened by COPD/ILD, it is not caused by COPD. The examiner cited a phenomenon in medical literature known as the overlap syndrome. However, the examiner did not provide a specific opinion addressing whether the Veteran's diagnosed obstructive sleep apnea is aggravated by his service-connected COPD/ILD. Therefore, an addendum opinion is warranted to address aggravation. Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Obtain all outstanding private and VA treatment records. Ask the Veteran to identify any private medical providers who have treated him for his conditions on appeal. After securing any necessary releases, the RO should request any relevant records that are not duplicative of those currently associated with the claims file. If any requested records are unavailable, the claims file should be annotated as such and the Veteran and his representative notified of such. 2. Schedule the Veteran for an appropriate VA examination to determine the current severity of his hemorrhoids and post pilonidal cystectomy, incision, and drainage of his perineal abscess. The claims file and a copy of this remand should be reviewed by the examiner in conjunction with the examination. All indicated studies should be conducted, and all findings reported in detail. The examiner must report all signs and symptoms necessary for rating the Veteran's hemorrhoids and post pilonidal cystectomy, incision, and drainage of his perineal abscess, under the applicable rating criteria. A complete rationale should be provided for any opinion provided. 3. Obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran's sleep apnea is caused OR aggravated by his service-connected COPD/ILD. The examiner is advised that the term "aggravation" is defined for legal purposes as a chronic worsening of the underlying condition beyond its natural progression. (Continued on the next page) Please review and discuss the October 2015 VA examination report. The examiner must provide a complete rationale for any opinion expressed. If the examiner is unable to reach an opinion without resort to speculation, he or she should explain the reasons for this inability and comment on whether any further tests, evidence, or information would be useful in rendering an opinion. A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lent, Edward 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.