Citation Nr: 21063797 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 17-11 835 DATE: October 18, 2021 REMANDED Entitlement to service connection for right arm pain and numbness is remanded. Entitlement to service connection for left arm pain and numbness is remanded. Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 2009 to December 2009 and from January 2011 to May 2011. In July 2021, the Veteran testified at a videoconference hearing before the undersigned, and a transcript of that hearing is of record. 1. Service connection for right and left arm pain and numbness. The Veteran was most recently afforded a bilateral arm condition VA disability benefits questionnaire (DBQ) in March 2015. The Board notes that this opinion was not accompanied with a VA examination for the Veteran's bilateral arm condition. The March 2015 DBQ indicated that the Veteran's bilateral arm condition was not related to service, to include due to environmental hazards in the Gulf War. The rationale provided stated that the Veteran did not make any complaints about arm pain during active service. VA examiners may not rely on the absence of evidence in service medical records to provide a negative opinion. See, Dalton v. Nicholson, 21 Vet. App. 23 (2007). Thus, as the examiner did not comment on the Veteran's lay statements that her pain and numbness in her arms began during active service, the Board finds that a new VA medical opinion and a VA examination is necessary. Snuffer, 10 Vet. App. 400; Caffrey, 6 Vet. App. 377. 2. Service connection for sleep apnea. The Board notes that to date the Veteran has not been afforded with a VA medical examination and opinion on whether her sleep apnea is related to service. VA treatment records indicate that the Veteran has a current diagnosis of sleep apnea from February 2016 and has reported difficulty sleeping since experiencing military sexual trauma during active service in 2011. Additionally, the Veteran indicated during the July 2021 Board hearing that her sleeping difficulty stems from her service-connected PTSD issues. The Board acknowledges that the Veteran is service-connected for PTSD based on her military sexual trauma and claimed insomnia and nightmares. Therefore, the medical evidence is insufficient, as the record lacks an adequate opinion regarding the likelihood of a medical nexus between the in-service event (military sexual assault and/or PTSD symptoms) and a current disability (sleep apnea). See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("Without a medical opinion that clearly addresses the relevant facts and medical science, the Board is left to rely on its own lay opinion, which it is forbidden from doing."); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006). As such, a remand is warranted to assist in determining the etiology of the Veteran's sleep apnea. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the etiology of the Veteran's bilateral arm condition. The examiner must review the Veteran's claims file and explain the complete rationale for all opinions expressed and conclusions reached. All diagnoses related to the Veteran's bilateral arm condition should be listed. The examiner should provide the following opinions: Whether the Veteran's bilateral arm condition is at least as likely as not (a probability of 50 percent or greater) related to active service or had its onset in service, to include as due to environmental hazards in the Gulf War. The examiner is advised that the Veteran is competent to report her symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. The entire claims file, including a copy of this REMAND, must be reviewed. 2. Schedule the Veteran for a VA examination to determine the etiology of the Veteran's sleep apnea. The examiner must review the Veteran's claims file and explain the complete rationale for all opinions expressed and conclusions reached. All diagnoses related to the Veteran's sleeping difficulties should be listed. The examiner should provide the following opinions: a) Whether the Veteran's sleep apnea is at least as likely as not (a probability of 50 percent or greater) related to active service or had its onset in service, to include environmental hazards in the Gulf War. b) Whether the Veteran's sleep apnea is at least as likely as not (a probability of 50 percent or greater) related to service-connected PTSD. c) Whether the Veteran's sleep apnea is at least as likely as not (a probability of 50 percent or greater) aggravated by service-connected PTSD. When providing the following opinion for the Veteran's sleep apnea, to include as secondary to service-connected PTSD, the examiner MUST discuss and comment on: (a.) The Veteran's service-connected PTSD, which was due in part from the Veteran's military sexual trauma, insomnia, and nightmares; and (b.) The Veteran's lay statement's that she has had difficulty sleeping since experiencing her military sexual trauma in 2011 and difficulty sleeping from her PTSD symptoms. The examiner is advised that the Veteran is competent to report her symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. (Continued on the next page) A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. The entire claims file, including a copy of this REMAND, must be reviewed. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Dourmashkin 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.