Citation Nr: 21071236 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 20-29 832 DATE: November 30, 2021 REMANDED Service connection for obstructive sleep apnea is remanded. Service connection for bilateral foot fungus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1970 to March 1972, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2016 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO). These matters were before the Board in August 2021 and were remanded for further development. 1. Service connection for obstructive sleep apnea is remanded. In accordance with the August 2021 Board remand instructions, the Veteran was afforded a September 2021 VA examination during which the conducting physician opined that it was less likely than not that the Veteran's obstructive sleep apnea was causally related to any of his service-connected disabilities. As a rationale, the physician explained that obstructive sleep apnea occurs when throat muscles relax and the airway narrows or closes as one breathes in and is caused by a blockage of the airway, usually when the soft tissue in the back of the throat collapses during sleep. The physician acknowledged that the Veteran submitted medical treatises which suggest some association of obstructive sleep apnea and heart disease but reasoned that association and correlation is not causation. The physician noted that they discovered a crowded oropharynx with a small upper airway and that is the main cause of the Veteran's obstructive sleep apnea diagnosed in 2016, over 40 years post-discharge from service. The physician further explained that the Veteran's service-connected diabetes was diagnosed after the Veteran's obstructive sleep apnea was diagnosed and would have no medical relationship to the oral airway obstruction causing the apnea. The physician also noted that neither the Veteran's service-connection ischemic heart disease or diabetes are currently aggravating his obstructive sleep apnea beyond its natural progression. The Board finds that the physician's opinion with respect to direct service connection is inadequate because they failed to discuss the Veteran's statement that his issues with poor sleep began in the 1970s. Accordingly, the Veteran has not been provided an adequate VA examination and this matter must be remanded once again. See Barr v. Nicholson, 21 Vet. App. 303 (2007). 2. Service connection for bilateral foot fungus is remanded. In accordance with the August 2021 Board remand instructions, the Veteran was afforded a September 2021 VA examination during which the conducting physician opined that the only service-connected disability that could have any medical relationship to the Veteran's bilateral foot fungus is his service-connected diabetes with neuropathy. As a rationale, the physician explained that the Veteran's bilateral foot fungus was diagnosed in 2005 which was over 10 years before he was diagnosed with diabetes in 2016. The physician further explained that the Veteran's bilateral foot fungus has been stable since 2005 with no indication of aggravation by any condition including his diabetes. The Board finds that the physician's opinion is inadequate because they only addressed service connection on a secondary basis without discussing direct service connection. Additionally, the physician failed to discuss the Veteran's statement that his issues with bilateral foot fungus began during service and has continued "off and on" since then. See July 2020 VA examination. Accordingly, the Veteran has not been provided an adequate VA examination and this matter must be remanded once again. See Barr supra. The matters are REMANDED for the following action: 1. Please note that this Veteran's case has been advanced on the docket and, by law, ALL remanded claims must be processed expeditiously. 2. Schedule the Veteran for an examination by an appropriate clinician to determine whether it is at least as likely as not (50 percent or better) that the Veteran's obstructive sleep apnea was caused by or otherwise causally related to an in-service injury event or disease. 3. Schedule the Veteran for an examination by an appropriate clinician to determine whether it is at least as likely as not (50 percent or better) that the Veteran's bilateral foot fungus was caused by or otherwise causally related to an in-service injury event or disease. (Continued on the next page) The Veteran is competent to report his symptoms, experiences, and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran's reports of symptomatology, they must provide a reason. A comprehensive rationale for all opinions must be provided. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alexander Bahus 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.