Citation Nr: 21068114 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 10-23 151 DATE: November 9, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to a total disability rating due to unemployability (TDIU) for the period prior to February 21, 2007 is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1989 to September 1996. This matter came before the Board of Veterans Appeals (Board) on appeal from October 2007 and June 2008 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). May 2015, July 2017 and March 2021 Board decisions remanded the issues on appeal for further development. 1. Entitlement to service connection for obstructive sleep apnea In September 2021 the Veteran submitted an article that supports the link between skin disorders and sleep, entitled, "Skin disorders and sleep in adults: where is the evidence?" While medical treatises that are not specific to a particular veteran's disability picture (like those submitted in this case) are generally insufficient, alone, to establish linkage for service-connection purposes, see, e.g., Wallin v. West, 11 Vet. App. 509, 514 (1998); Libertine v. Brown, 9 Vet. App. 521, 523 (1996), such medical treatise evidence may nevertheless provide "'important support' for service connection" outside of establishing linkage. McCray v. Wilkie, 31 Vet. App. 243, 255 (2019). Here, the Board finds that remand for a new VA examination to consider the medical treatise evidence submitted by the Veteran is required. Entitlement to a total disability rating due to unemployability (TDIU) for the period prior to February 21, 2007 The Veteran contends that he has been unemployable due to service-connected disabilities since he stopped working in 1997. A September 2016 Rating Decision granted TDIU effective February 21, 2007, the date he met the eligibility criteria. The period prior to February 21, 2007 is therefore still on appeal. When a veteran is unable to secure and follow a substantially gainful occupation due to service-connected disabilities but fails to meet the percentage requirements for TDIU set forth in 38 C.F.R. § 4.16 (a), the case may be referred to appropriate VA officials for extraschedular consideration of the assignment of a TDIU rating. 38 C.F.R. § 4.16 (b). The Board does not have the authority to assign an extraschedular total disability rating based on individual unemployability in the first instance. Bowling v Principi, 15 Vet. App. 1 (2001). Here, the Veteran has a combined rating of 60 percent for the period prior to February 21, 2007. He has already been found unemployable due to his service-connected disabilities. Accordingly, the Board finds that the criteria for referral of the claim for extraschedular consideration of a TDIU rating have been met. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from the examiner who provided the May 2021 VA medical opinion as to the relationship between obstructive sleep apnea and the service connected skin disability, granuloma annulare with psoriaform dermatitis. An examination should only be scheduled if deemed needed by the examiner. The examiner should review the claim file and provide a complete rationale for all opinions expressed. The examiner should review medical treatise evidence entitled "Skin disorders and sleep in adults: where is the evidence?" submitted in September 2021 and state whether the etiology opinion as to OSA changes given the contents of the treatise. If the May 2021 examiner is not available, the claim file should be forwarded to a new examiner who, upon review of the claim file, should provide an opinion as to whether it is at least as likely as not that the Veteran's obstructive sleep apnea was caused or aggravated by his service connected skin condition, granuloma annulare with psoriaform dermatitis. A complete rationale for any opinion rendered must be provided. 2. Refer the case to the Director, Compensation Service, for an extraschedular determination as to whether the Veteran was entitled a total disability rating based on individual unemployability due to service-connected disabilities during the period prior to February 21, 2007, in accordance with the provisions of 38 C.F.R. § 4.16 (b). The rating board should include a full statement as to the Veteran's service-connected disabilities, employment history, educational and vocational attainment and all other factors having a bearing on the issue. (Continued on next page) 3. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. Velez Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Akkad 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.