Citation Nr: 21068399 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 18-18 872A DATE: November 10, 2021 ORDER Service connection for a skin condition on the feet is granted. REMANDED Entitlement to service connection for sleep apnea is remanded. FINDING OF FACT The Veteran's current skin condition on the feet, diagnosed as onychomycosis on the nails, is as likely as not attributable to in-service occurrences consistent with his duties during active service. CONCLUSION OF LAW With resolution of reasonable doubt in the Veteran's favor, the criteria for entitlement to service connection for a skin condition on the feet have been satisfied. 38 U.S.C. §§ 1110, 1131, 1154(a), 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from August 1979 to August 1982 and in May 1992. Entitlement to service connection for a skin condition on the feet Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. The Veteran has a current diagnosis of a skin condition on the feet, specifically onychomycosis on the bilateral hallux nails, during the appeal period as noted in a February 2017 VA treatment record. As a result, the Board finds the element of a current disability has been met in this case. Next, since separation from service, the Veteran has asserted consistent and credible in-service occurrences consistent with the circumstances and assigned duties during his periods of active service. See 38 U.S.C. § 1154(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994). In the February 2018 VA Form 21-0958, the Veteran reported that his boots were constantly wet. At the August 2021 Board hearing, he reported in-service exposure to swampy conditions, his feet got soaked in combat boots, and he could never dry them out as result of his duties with a combat support unit and building ribbon bridges in the water and across creeks. Additionally, review of his service personnel records documents his military occupational specialty (MOS) included armor crewman and bridge crewman. As a result, the Board finds the element of an in-service occurrence has been met in this case. Lastly, the Veteran contends that his symptoms of a skin condition on the feet have continued after service and continue to this day. Specifically, the Veteran reported he has had discoloration to the nails since 1982 at the February 2017 VA treatment session and reported that his toenails started to become discolored within his last year of active duty in the February 2018 VA Form 21-0958. The Board affords considerable probative weight to the Veteran's statements regarding in-service onset and continuity of symptoms. The Veteran is competent to report the occurrence and duration of symptoms of toenail fungus because such symptomatology is observable. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board finds also finds that there is no probative contrary medical opinion of record. As a result, the Board finds the element of a nexus between the Veteran's skin condition on the feet, diagnosed as onychomycosis on the bilateral hallux nails, and his in-service occurrences consistent with his MOS duties during active service has been met in this case. For the reasons and bases discussed above and after resolving all reasonable doubt in favor of the Veteran, the Board finds that service connection is warranted for a skin condition on the feet on a direct basis. See 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS FOR REMAND Entitlement to service connection for sleep apnea In the February 2018 VA Form 21-0958 and April 2018 VA Form 9, the Veteran reported his sleep apnea stated during active duty and has had symptoms since service. In February 2018 and July 2021, he submitted lay statements of those who reported their observations of the Veteran snoring and not breathing during his periods of active service. At the August 2021 Board hearing, the Veteran also reported being sleep deprived while out in the field and not getting constant sleep based on the nature of his MOS duties with a combat support unit. Since separation from active service, review of VA treatment records documents private sleep study results in March 2015 showed a diagnosis of severe obstructive sleep apnea. As such, the Board finds that additional development is needed to determine the etiology of sleep apnea on a direct basis. 38 U.S.C. § 5103A(a) (2012); 38 C.F.R. §§ 3.159, 3.303 (2020); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board emphasizes that it is not determining whether or not the Veteran's assertion of sleep apnea symptoms since service is credible at this time, as the additional development set forth in the directives below could impact that determination. The matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records after February 2017. 2. Schedule the Veteran for an examination with an appropriate clinician for his sleep apnea. The entire claims file and a copy of this remand must be made available to the examiner for review. For the purposes of this remand only, and for the limited purpose of conducting the examination and providing a medical opinion, the examiner should assume that the Veteran's assertion of sleep apnea symptoms since service is true. If there is a medical reason to doubt its veracity, the examiner should explain why the Veteran's recollection is inconsistent with the principles of medical science and/or the evidence in this case. Although an independent review of the claims file is required, the Board calls the examiner's attention to the following: March 2015 private sleep study results shows diagnosis of severe obstructive sleep apnea In February 2018 and July 2021, lay statements note reported observations of the Veteran snoring and not breathing during his periods of active service In the February 2018 VA Form 21-0958 and April 2018 VA Form 9, the Veteran reported his sleep apnea stated during active duty and has had symptoms since service Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's obstructive sleep apnea (even if since resolved) began during active service or related to an incident of service, to include consideration of lay assertions. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 3. Then, review the examination report and medical opinion provided to ensure that the requested information was provided. If any report or opinion is deficient in any manner, the AOJ must implement corrective procedures. 4. Then, readjudicate the claim. If the decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Carter, 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.