Citation Nr: 21069608 Decision Date: 11/19/21 Archive Date: 11/19/21 DOCKET NO. 15-03 509 DATE: November 19, 2021 REMANDED Service connection for insomnia, diagnosed as depressive disorder, is remanded. Service connection for a low back disability is remanded. REASONS FOR REMAND The Veteran had active service in the U.S. Army from January 1975 to January 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision. It was previously remanded in August 2018 for additional development. In April 2016, the Veteran testified before a Veterans Law Judge who is no longer at the Board. VA sent the Veteran a letter in October 2021 notifying him of the opportunity to testify at an additional hearing. A November 2021 Report of General Information shows that the Veteran declined this option during a phone call with VA personnel. Insomnia, diagnosed as depressive disorder In August 2018, the Board remanded this claim for a VA examination to determine whether the Veteran's claimed insomnia was proximately due to, or aggravated by, his service-connected tinnitus or deviated septum. The October 2020 examination and opinion that were obtained do not adequately address these questions. The examiner stated that the Veteran had depressive disorder, and that chronic sleep impairment was a component of that disability. He did not have a separate diagnosis of insomnia. The examiner went on to state that depressive disorder was not proximately due to tinnitus because there was no evidence in the available records which showed such a connection. This opinion is deficient for several reasons. First, the examiner's rationale that depressive disorder is not due to tinnitus because there were no records to that effect does not address a statement from the Veteran during a November 2013 VA examination that tinnitus causes some difficulties falling and staying asleep. Second, the examiner did not address whether tinnitus aggravated the diagnosed depressive disorder beyond its normal progression. Third, the examiner did not address whether depressive disorder was caused or aggravated by the Veteran's deviated septum. On remand, a supplemental opinion should be obtained. Low back disability In August 2018, the Board remanded this claim to obtain a VA examination addressing the relationship, if any, between the Veteran's lumbar spine degenerative arthritis and his duties in service, including heavy lifting and jarring impacts from riding in a tank. It does not appear that this examination was provided, and no supplemental statement of the case was generated after the prior remand. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from April 2021 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's insomnia/depressive disorder is at least as likely as not proximately due to service-connected tinnitus and/or deviated septum or aggravated beyond its natural progression by service-connected tinnitus and/or deviated septum. In forming these opinions, the examiner should address a November 2013 statement from the Veteran that tinnitus caused some difficulties falling and staying asleep. The examiner should provide a complete rationale to support the opinion(s). If an additional examination is necessary to provide the requested opinions, one should be scheduled. 3. Schedule the Veteran for a VA examination for his lumbar spine disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Is the Veteran's low back disability at least as likely as not related to service, including heavy lifting, jarring impacts from riding in a tank, and/or back pain reported in May 1975 in connection with a viral upper respiratory infection diagnosis? The examiner should provide a complete rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of his/her in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his/her current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.