Citation Nr: 21064431 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 14-07 142A DATE: October 20, 2021 REMANDED Entitlement to an initial compensable evaluation for tinea pedis 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 from June 1973 to June 1976 and from January 2004 to April 2005. He also had additional service in the Alabama Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from April 2011 and February 2014 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). In April 2016, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In August 2016, the Board remanded the claim for service connection for sleep apnea for further development. In August 2018, the Board remanded both of the issues on appeal for further development. The case has since been returned to the Board for appellate review. Regarding the issue of entitlement to a compensable evaluation for bilateral tinea pedis, in VA treatment records dated in May 2018, May 2019, and August 2019, the Veteran reported that he received treatment by a private podiatrist. However, no private podiatry records have been associated with the record since 2014. Therefore, a remand is necessary. Regarding the issue of entitlement to service connection for sleep apnea, the Board most recently remanded the claim to obtain an additional VA medical opinion in August 2018. In the remand, the Board found that the December 2016 VA medical opinion was inadequate because the examiner did not address whether in-service symptoms may have been indicative of subsequently diagnosed sleep apnea. In addition, the Board found that the examiner did not provide a supporting rationale for her opinion that PTSD does not cause or aggravate sleep apnea. Thereafter, the Veteran was afforded a VA examination in June 2019. The VA examiner opined that the Veteran's sleep apnea was less likely than not incurred in or caused by service. However, the examiner did not address whether any in-service symptoms may be indicative of subsequently diagnosed sleep apnea. Stegall v. West, 11 Vet. App. 268 (1998) (a remand by the Court or the Board confers on the veteran or other claimant, as a matter of law, a right to compliance with the remand orders). Therefore, the Board finds that an additional medical opinion is needed. The matters are REMANDED for the following action: 1. The AOJ should request that the Veteran provide the names and addresses of any and all health care providers who treated the Veteran for tinea pedis and sleep apnea. A specific request should be made for authorization to obtain records from the Veteran's private podiatrist, as noted in May 2018, May 2019, and August 2019 VA treatment records. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA treatment records. 2. After completing the above development, the AOJ should refer the Veteran's claims file to a suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of the Veteran's obstructive sleep apnea. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran's sleep apnea manifested in or is otherwise causally or etiologically related to his military service, to include any symptomology therein. In rendering this opinion, the examiner should consider the Veteran's report that he experienced symptoms while serving in Iraq. See, e.g., March 2014 substantive appeal. The examiner should also provide an opinion as to whether it is at least as likely as not that the Veteran's sleep apnea was either caused by or aggravated by his service-connected PTSD. In rendering this opinion, the examiner should specifically consider the medical articles submitted by the Veteran's representative. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ should review the examination report to ensure that it is in compliance with this remand. If the reports are deficient in any manner, the AOJ should implement corrective procedures. 4. After completing these actions, the AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Osegueda, 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.