Citation Nr: 21069508 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 18-50 247 DATE: November 18, 2021 REMANDED Entitlement to service connection for a right leg condition is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from February 2002 to April 2006, and from October 2006 to November 2007. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board denied the claims on appeal in an August 2019 decision. The Veteran appealed to the U.S. Court of Appeals for Veterans Claims (Court). In March 2021, the Court issued a memorandum decision vacating and remanding the Board's decision on these claims. Entitlement to service connection for a right leg condition The Court held that the Board, in denying the Veteran's claim for service connection for a right leg condition, relied on an inadequate medical examination from December 2017. VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The medical opinion must support its conclusions with data and reasoning that the Board can follow. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-304 (2008). The December 2017 VA examination noted that the Veteran reported frequent symptoms of numbness and tingling in his right leg, but stated that there was "nothing suggestive of radiculopathy" and "no objective evidence of a right leg condition." The examiner did not give a rationale for either of these conclusions, nor did they give a reason for discounting the Veteran's testimony. Because of the deficiencies in the December 2017 examination, a new examination is necessary. Entitlement to service connection for sleep apnea The Court held that the Board erred in denying the Veteran's claim for service connection for sleep apnea without addressing whether his sleep apnea is related to his service-connected traumatic brain injury (TBI). The Veteran's January 2019 VA examination regarding his sleep apnea did not discuss a potential relationship between sleep apnea and a TBI. Furthermore, the January 2019 examination gave an inadequate rationale for finding that the Veteran's sleep apnea was less likely than not related to his service-connected anxiety disorder and alcohol use disorder. The examiner stated that "sleep apnea is not medically accepted to be due to or the result of anxiety disorder or alcohol use," but did not indicate that they had reviewed any medical literature or other sources. It is also unclear what "not medically accepted" means in this context; has a link between sleep apnea and anxiety disorder been researched but not found? Is there no plausible mechanism by which anxiety disorder or alcohol use disorder could cause or aggravate sleep apnea? Is there conflicting data regarding a potential link, or does all of the medical literature point against a link, or is there simply no research on the issue? To obtain a more complete medical opinion regarding the etiology of the Veteran's sleep apnea, a remand is required. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician regarding the nature and etiology of the Veteran's right leg condition. If the clinician believes an in-person or telehealth examination is necessary, one should be scheduled. The examiner shall be provided with the complete claims file, including a copy of this remand. After certifying that they have reviewed the entire claims file, the examiner should answer the following: (a) Does the Veteran currently have any medical condition affecting his right leg? List all conditions. (b) For each condition listed above, is it at least as likely as not (50 percent or greater probability) that the condition had its onset in service, or is otherwise related to an in-service injury, disease, or event? (c) For each condition listed above, is it at least as likely as not that the condition was caused or aggravated by any of the Veteran's service-connected disabilities, to include degenerative disc disease and traumatic brain injury? (d) If the Veteran's right leg condition is unrelated to his military service, or to any service-connected disability, what is its likely etiology? (e) If the Veteran does not have a right leg condition, what is the likely explanation for his past reports of numbness and tingling in his right leg? The examiner must offer a complete rationale for every conclusion reached, citing any record evidence or medical literature relied upon. Proper consideration shall be given to all lay evidence of record. If the examiner cannot reach a conclusion on an issue without resorting to speculation, the examiner must explain why. 2. Obtain an opinion from an appropriate clinician regarding the nature and etiology of the Veteran's sleep apnea. If the clinician believes an in-person or telehealth examination is necessary, one should be scheduled. The examiner shall be provided with the complete claims file, including a copy of this remand. After certifying that they have reviewed the entire claims file, the examiner should answer the following: (f) Is it at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea had its onset in service, or is otherwise related to an in-service injury, disease, or event? (g) Is it at least as likely as not that the Veteran's sleep apnea was caused or aggravated by any of the Veteran's service-connected disabilities, to include traumatic brain injury and anxiety disorder with alcohol use disorder? (h) If the Veteran's sleep apnea is unrelated to his military service, or to any service-connected disability, what is its likely etiology? The examiner must offer a complete rationale for every conclusion reached, citing any record evidence or medical literature relied upon. Proper consideration shall be given to all lay evidence of record. If the examiner cannot reach a conclusion on an issue without resorting to speculation, the examiner must explain why. Jenna Brant Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shermila Sundquist 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.