Citation Nr: 21073694 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 17-39 709 DATE: December 10, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected disability, is remanded. Entitlement to service connection for a left hand disability, to include disability of the thumb, is remanded. Entitlement to an initial rating in excess of 10 percent for sinusitis is remanded. Entitlement to an initial, compensable rating for allergic rhinitis is remanded. Entitlement to an initial, compensable rating for chronic obstructive pulmonary disease (COPD) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1990 to June 1993. This matter comes before the Board of Veterans Appeals (Board) on appeal of a May 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In April 2021, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected disability The Veteran asserts that his sleep apnea is related to service, noting symptoms of sleep difficulties since service. In the alternative, the Veteran asserts that his sleep apnea is secondary to his service-connected disabilities, to include COPD, sinusitis, rhinitis, and posttraumatic stress disorder (PTSD). Although the Veteran was afforded a VA examination as to whether his sleep apnea is secondary to service-connected disability, the examiner did not address service connection on a direct basis. In addition, the examiner did not opine as to whether a service-connected disability aggravated the claimed sleep apnea. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) (Where an examiner finds that a service-connected disability did not cause a claimed disorder, it is not clear that aggravation has been addressed). Accordingly, remand is required for an additional examination and opinion. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Entitlement to service connection for a left hand disability, to include disability of the thumb, is remanded. The Veteran reports that his hand/thumb disability originated in service as a result of an incident when a fire extinguisher blew up in his hand and he dislocated his thumb. Service treatment records document injury to the left hand from a fire extinguisher in May 1993. During the Veteran's Board hearing, he testified that he experienced decreased strength and grip strength in the left hand and thumb after service, which has persisted. The Veteran was afforded a VA examination in July 2015, at which time the examiner indicated that the Veteran did not have a hand or finger disability. Since that time, the Veteran submitted a July 2021 letter from a VA physician discussing the fire extinguisher injury to the left hand, but noting that there was likely some injury and stress to both hands. The Veteran had loss of strength in the thumb and tremor, as well as chronic right hand pain. Then physician then went on to state that the Veteran's hand arthritis and disability are likely service-connected. It is unclear from this statement as to the exact nature and diagnosis of the Veteran's left hand/thumb disability. The physician also provided no supporting medical rationale as to diagnosis or etiology. Given the foregoing, the Board finds that remand is warranted to afford the Veteran an additional examination with medical opinion based on full consideration of the Veteran's documented medical history and assertions, and supported by clearly-stated rationale. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. 3. Entitlement to an initial rating in excess of 10 percent for sinusitis 4. Entitlement to an initial, compensable rating for allergic rhinitis 5. Entitlement to an initial, compensable rating for COPD The Board notes that the Veteran was last afforded a VA examination pertaining to his service-connected sinusitis, rhinitis, and COPD disabilities in 2016. Since that time, the Veteran has reported worsening symptoms, as indicated during the April 2021 Board hearing. The Board therefore finds that additional examinations, with more contemporaneous findings, are warranted. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. See also Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the veteran with a thorough and contemporaneous medical examination); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered contemporaneous). The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims folder outstanding treatment records, to specifically include updated VA treatment records. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of the claimed sleep apnea. Any indicated tests should be accomplished. The examiner should review the record prior to examination, and elicit from the Veteran a detailed medical history. Then, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea 1) had its onset in service or is otherwise medically related to service; or 2) was caused by or aggravated (increased in severity) by the Veteran's service-connected PTSD, sinusitis, allergic rhinitis and/or COPD. The examiner is also requested to specifically consider and address the medical articles discussed by the Veteran in his April 2021 Board hearing testimony regarding a relationship between sleep apnea and the Veteran's service-connected disabilities, as well as the Veteran's report as to onset of sleep symptoms. The examiner is also advised that the Veteran is competent to report symptoms and treatment, and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinion. The examiner should set forth all examination findings, together with the complete rationale for the conclusions reached. 3. Schedule the Veteran for a VA examination to determine the nature and etiology of the claimed left hand/thumb disability. Any indicated tests should be accomplished. The examiner should review the record prior to examination, and elicit from the Veteran a detailed medical history. The examiner should note all left hand/finger/thumb disabilities. Then, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any hand/finger/thumb disability had its onset in service or is otherwise medically related to service, to include the fire extinguisher injury noted in service. In rendering a diagnosis and opinion, the examiner should consider and address the 2021 medical report noting loss of thumb strength, thumb tremor, and arthritis. The examiner is also advised that the Veteran is competent to report symptoms and treatment, and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinion. The examiner should set forth all examination findings, together with the complete rationale for the conclusions reached. 3. Schedule the Veteran for VA examinations to ascertain the current severity and manifestations of the Veteran's service-connected sinusitis, allergic rhinitis, and COPD. (Continued on the next page) The claims file should be made available to the examiner(s) for review in connection with the examinations. All tests or studies deemed necessary should be conducted, and the results should be reported in detail. The examiner should also comment on the impact of the Veteran's sinusitis, allergic rhinitis, and COPD on his ability to work. The examiner must provide a complete rationale for all the findings and opinions. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. E. Wilkerson, 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.