Citation Nr: 21073847 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 11-31 499 DATE: December 10, 2021 ORDER Entitlement to service connection for traumatic brain injury (TBI) is denied. Entitlement to service connection for a back disability is denied. Entitlement to service connection for a bilateral ankle disability is denied. Entitlement to service connection for vertigo (claimed as dizziness) is denied. Entitlement to service connection for a respiratory condition is denied. Entitlement to service connection for a skin condition other than scarring alopecia is denied. REMANDED Entitlement to service connection for an eye disorder, to include light sensitivity is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a vestibular disorder other than vertigo is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for fibromyalgia (claimed as joint disorder) is remanded. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had residuals of TBI at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had a back disability at any time during or approximate to the pendency of the claim. 3. The preponderance of the evidence is against finding that the Veteran's bilateral ankle disability began during active service, or is otherwise related to an in-service injury or disease. 4. The preponderance of the evidence of record is against finding that the Veteran has had vertigo at any time during or approximate to the pendency of the claim. 5. The preponderance of the evidence of record is against finding that the Veteran has had a respiratory condition at any time during or approximate to the pendency of the claim. 6. The preponderance of the evidence is against finding that the Veteran's skin condition other than scarring alopecia began during active service, or is otherwise related to an in-service injury or disease. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for traumatic brain injury (TBI) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for entitlement to service connection for a back disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for entitlement to service connection for a bilateral ankle disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for entitlement to service connection for vertigo (claimed as dizziness) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for entitlement to service connection for a respiratory condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for entitlement to service connection for a skin condition other than scarring alopecia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from January 1988 to April 1988, from October 2003 to June 2004, and from August 2006 to January 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Board remanded the issues above for further development. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). To establish service connection for the claimed disorder, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303 ; Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). In the absence of proof of present disability there can be no successful claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Degmetich v. Brown, 104 F.3d 1328 (1997) (interpreting 38 U.S.C. § 1131 as requiring the existence of a present disability for VA compensation purposes). To be present as current disability, there must be evidence of the condition at some time during the claim period or approximate thereto. See Gilpin v. West, 155 F. 3d 1353, 1356 (Fed. Cir. 1998); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves); see also Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013) (the Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency). For veterans who served in the Southwest Asia theater of operations during the Persian Gulf War, service connection may also be established for chronic disability that cannot be attributed to a known clinical diagnosis (undiagnosed illness) or for a medically unexplained multi-symptom illness (e.g., chronic fatigue syndrome, fibromyalgia, or irritable bowel syndrome). 38 C.F.R. § 3.317. 1. Entitlement to service connection for traumatic brain injury (TBI) The Veteran is seeking service connection for TBI. Concerning the Veteran's TBI, the Veteran has not submitted an explanation as to how he has been found to have a TBI and how his TBI is related to his time in service. The Veteran's service treatment records (STRs) and post service treatment records are negative for any diagnosis of TBI. The Veteran was afforded a VA examination in June 2016. The examiner indicated that the Veteran has not been diagnosed with traumatic brain injury. Thus, the Board concludes that the Veteran does not have current TBI residuals, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In sum, after weighing the lay and medical evidence, the Board finds that the Veteran has not had residuals of a TBI during the appeal period. As there is no competent medical evidence of this disability, service connection must be denied. Brammer, 3 Vet. App. at 225. 2. Entitlement to service connection for a back disability The Veteran is seeking service connection for a back disability. On his VA Form 9, the Veteran expressed that he worked with heavy equipment such as large vehicles, tanks, missiles, and weapons. The Veteran noted that the constant loading and unloading hurt his back, knees, neck, and other parts of his body. The Veteran expressed that he has had continuous unbearable pain. The Veteran's service treatment records (STRs) and post service treatment records are negative for any diagnosis of a back disability. The Veteran was afforded a VA examination in June 2016. The examiner indicated that the Veteran has not been diagnosed with a back condition. The Veteran denied a back condition or pain at the examination. Range of motion was all normal. Thus, the Board concludes that the Veteran does not have a current back disability, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Further, there is no credible persuasive evidence that the Veteran suffers from back symptoms productive of chronic functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that pain resulting in functional impairment constitutes a disability as contemplated in 38 U.S.C. § 1110, even in the absence of a presently diagnosed condition). The Board acknowledges the Veteran's belief that he experienced a back disability and pain as a result of service. However, none of the clinical records show such a diagnosis of a back disability. In sum, after weighing the lay and medical evidence, the Board finds that the Veteran has not had a back disability during the appeal period. As there is no competent medical evidence of this disability, service connection must be denied. Brammer, 3 Vet. App. at 225. 3. Entitlement to service connection for a bilateral ankle disability The Veteran is seeking service connection for a bilateral ankle disability. On his VA Form 9, the Veteran expressed that he worked with heavy equipment such as large vehicles, tanks, missiles, and weapons. The Veteran noted that the constant loading and unloading hurt his back, knees, neck, and other parts of his body. The Veteran expressed that he has had continuous unbearable pain. The Veteran was afforded a VA examination in June 2016. The examiner diagnosed the Veteran with right deltoid ligament sprain. The Veteran stated that five years ago, while at his house, the Veteran fell. The Veteran denied that his condition happened while on active military service. The examiner opined that the Veteran's right ankle sprain is a disease with a clear and specific etiology and diagnosis and is not related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner stated that the medical evidence does not support the fact that the right ankle sprain condition is related to a specific exposure event experienced by the Veteran during service in Southwest Asia. In addition, the examiner noted that the Veteran's service treatment records are silent for the claimed condition and the Veteran's ankle condition began after active military service in 2010. The examiner stated that the Veteran's right ankle sprain is unrelated to service and that his condition occurred after active military service, at the Veteran's house. After carefully reviewing the record, the Board finds that the preponderance of the evidence is against the Veteran's claim. As noted above, there is no evidence that the Veteran developed an ankle disability in active service, nor is there any evidence that the Veteran's ankle disability was incurred in service (on the contrary, the evidence reflects that he incurred a right ankle disability after a fall at his home, following his separation from active duty). The Board finds the June 2016 VA examiner's medical opinion highly probative to the issue of whether the Veteran has an ankle disability related to service. The examiner possesses the necessary education, training, and expertise to provide the requested opinions. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Significantly, the Veteran has not presented or identified any medical opinion that supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In this regard, the Board acknowledges that the Veteran is competent to relate symptoms within the realm of his personal knowledge, just as he is competent to relate what he has been told by an examiner. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the question of whether his current ankle disability is related to his service is a complex medical question, not capable of lay observation. See Jandreau, 492 F.3d at 1376 (noting that lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 308 -09 (2007) (finding that lay testimony is competent to establish the presence of varicose veins). In short, because the evidence does not indicate that the Veteran has the appropriate training, experience, or expertise to provide a medical opinion concerning the etiology of his ankle disability, he is not competent to comment on its etiology. The Board acknowledges the Veteran's general contention that his ankle disability stems from service, especially loading and unloading heavy equipment such as large vehicles, tanks, missiles, and weapons. Unfortunately, he is not competent to substantiate this claim, and there is no other credible evidence substantiating the claims. In sum, the Board finds that the most probative evidence demonstrates that the Veteran's claim for an ankle disability did not develop in service or is otherwise related to service. For these reasons, service connection must be denied. 4. Entitlement to service connection for vertigo (claimed as dizziness) The Veteran is seeking service connection for vertigo. The Veteran's service treatment records (STRs) and post service treatment records are negative for any diagnosis of vertigo. The Veteran was afforded a VA examination in June 2016. The examiner noted that the Veteran denied having episodes of vertigo. In a December 2016 addendum opinion, the examiner expressed that the condition was less likely than not incurred in or caused by service. The examiner stated that the Veteran denied vertigo and the examination was absent of vertigo based on a normal Dix-Hallpike and negative Romberg test. As such, the examiner expressed that there is no diagnosis of vertigo and vertigo is less likely than not associated to service. Thus, the Board concludes that the Veteran does not have a current disability of vertigo, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In sum, the most probative evidence shows that the Veteran does not have a current vertigo disability, nor has he been diagnosed with such disability during or approximate to the appeal period. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (disallowing service connection where there was no current disability). See also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The preponderance of the evidence is against service connection, the benefit of the doubt doctrine does not apply, and the claim for a vertigo must be denied. 38 C.F.R. § §§ 3.102, 3.303. 5. Entitlement to service connection for a respiratory condition The Veteran is seeking service connection for a respiratory condition. On his VA Form 9, the Veteran expressed that he started having problems with his breathing during his deployment to Kuwait. The Veteran noted that he was exposed to harsh desert climate as well as toxins in the air from the petroleum wells and burn pits. The Veteran expressed that he has had continuous problems since service with his respiratory system. The Veteran was afforded a VA examination in June 2016. The examiner noted that the Veteran does not have a respiratory condition. The Veteran reported that he has never been diagnosed with a respiratory condition and he denies using any medication for a respiratory condition. The examiner stated that the available medical documents do not show any diagnosis related to a respiratory condition. The Veteran reported that he smoked for 15 years. Thus, the Board concludes that the Veteran does not have a current respiratory disability, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Presumptive service-connection under 38 C.F.R. § 3.317 is also not established in regards to the Veteran's respiratory condition. Though the Veteran did have active-duty service in the Southwest Asia Theater of operations during the Persian Gulf War, his problem breathing has not been found to be as the result of any diagnosed respiratory disability or respiratory condition. As stated in the June 2016 VA Gulf War examination, the Veteran was not found to have any diagnosed illnesses for which no etiology was established. 38 C.F.R. § 3.317 (a)(1)(i)-(ii). Moreover, 38 C.F.R. § 3.317 contains a requirement of chronicity, and the record is devoid of documentation of any chronic respiratory condition. Accordingly, the Board finds that service connection for a respiratory condition cannot be granted under the presumptive provisions of 38 C.F.R. § 3.317. The Board finds the VA examiners' medical opinions highly probative to the issue of whether the Veteran has a respiratory condition causing his difficulty breathing. The examiners possess the necessary education, training, and expertise to provide the requested opinions. Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Significantly, the Veteran has not presented or identified any medical opinion that either provides a current diagnosis of a respiratory condition, causation for his difficulty breathing, or supports the claim for service connection. VA adjudicators are not free to ignore or disregard the medical conclusions of a VA physician, and are not permitted to substitute their own judgment on a medical matter. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Willis v. Derwinski, 1 Vet. App. 66 (1991). In sum, after weighing the lay and medical evidence, the Board finds that the Veteran has not had a respiratory condition during the appeal period. As there is no competent medical evidence of this disability, service connection must be denied. Brammer, 3 Vet. App. at 225. 6. Entitlement to service connection for a skin condition other than scarring alopecia The Veteran is seeking service connection for a skin condition other than scarring alopecia, for which he is already service connected. On his VA Form 9, the Veteran noted that he was exposed to harsh desert climate as well as toxins in the air from the petroleum wells and burn pits. The Veteran expressed that he has had continuous problems since service with his skin. The Veteran was afforded a VA examination in June 2016. The Veteran was diagnosed with tinea unguium, traumatic purpura, and tinea corporis. The examiner stated that the Veteran's tinea unguium, tinea corporis, traumatic purpura, and scarring alopecia are conditions with a clear and specific etiology and diagnosis that are not caused by or a result of specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner stated that those conditions are not known to be caused by environmental hazardous exposures that the Veteran might have been exposed during his deployment in Southwest Asia. The examiner noted that the available service treatment records do not show or describe any of these conditions during his deployment to Southwest Asia. The examiner noted that the Veteran was diagnosed several years after service and therefore less likely related to service. After carefully reviewing the record, the Board finds that the preponderance of the evidence is against the Veteran's claim. Here, there is no evidence that the Veteran developed tinea unguium, traumatic purpura, and tinea corporis in active service. The only positive evidence indicating that his symptomatology developed in service are the Veteran's lay statements. In this regard, the Board acknowledges that the Veteran is competent to relate symptoms within the realm of his personal knowledge, just as he is competent to relate what he has been told by an examiner. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the question of whether his current skin condition other than scarring alopecia is related to his service is a complex medical question, not capable of lay observation. See Jandreau, 492 F.3d at 1376 (noting that lay witness capable of diagnosing dislocated shoulder); Barr v. Nicholson, 21 Vet. App. 308 -09 (2007) (finding that lay testimony is competent to establish the presence of varicose veins). In short, because the evidence does not indicate that the Veteran has the appropriate training, experience, or expertise to provide a medical opinion concerning the etiology of his skin conditions, he is not competent to comment on its etiology. The Board acknowledges the Veteran's general contention that his disabilities stem from service, especially being exposed to harsh desert climate as well as toxins in the air from the petroleum wells and burn pits. Unfortunately, he is not competent to substantiate this claim, and there is no other credible evidence substantiating the claims. In addition, the Veteran is not entitled to presumptive service connection under 38 C.F.R. § 3.317. Although it is conceded that the Veteran served in the Southwest Asia theater of operations during the Persian Gulf War, the medical evidence of record does not show that the Veteran's skin conditions cannot be attributed to any known clinical diagnosis. In fact, the Veteran's skin condition has been clinically diagnosed, which firmly rules out the possibility of it being a symptom of an undiagnosed illness. Additionally, as the medical evidence of record indicates that the Veteran's skin conditions have a definite etiology, there is no indication that such would qualify as part of a medically unexplained chronic multi symptom illness. Therefore, service connection for a skin condition under 38 C.F.R. § 3.317 is not warranted. In sum, the Board finds that the most probative evidence demonstrates that the Veteran's claim for a skin condition other than scarring alopecia did not develop in service or is related to his service in Southwest Asia. There is no opinion to the contrary. For these reasons, service connection must be denied. REASONS FOR REMAND 1. Entitlement to service connection for an eye disorder, to include light sensitivity is remanded. The Veteran is seeking service connection for an eye disorder. On his VA Form 9, the Veteran expressed that he started having problems with his eyesight during his deployment to Kuwait. The Veteran noted that he was exposed to harsh desert climate as well as toxins in the air from the petroleum wells and burn pits. The Veteran indicated that his eyes became sensitive to light and the heat of the region, and sunlight created havoc with his eyesight. The Veteran expressed that he has had continuous problems since service. The Veteran was afforded a VA examination in June 2016. The Veteran was diagnosed with bilateral nuclear sclerosis. The Veteran denied direct trauma to his eyes. The examiner stated that the Veteran was examined, and the only diagnosis made was nuclear sclerosis on both eyes. The examiner stated that there is no diagnosis of photophobia or light sensitivity. The examiner noted that upon eye examination with light (pupils, fundus exam, and slit lamp examination), the Veteran did not show light sensitivity to neither test. The examiner opined that nuclear sclerosis is an age-related condition due to yellowing of the crystalline lens with age and is not causing photophobia or other eye complications at present. The examiner stated that upon review of the Veteran's health administration records, there is no mention of photophobia of either eye. In an addendum opinion, dated in December 2016, the examiner stated that upon eye examination, the Veteran was diagnosed with bilateral nuclear sclerosis. The examiner stated that nuclear sclerosis is a disease with a clear and specific etiology and diagnosis. The examiner expressed that nuclear sclerosis is caused by denaturation of the crystalline lens proteins with age and can be accelerated by excessive exposure to ultraviolet rays. The examiner stated that the condition is normally expected to be diagnosed on a patient over 40 years of age. The examiner opined that nuclear sclerosis is not caused by environmental hazards and that environmental hazards cause external conditions on the conjunctiva of the eye such as allergic conjunctivitis and corneal conditions such as corneal abrasions or lacerations. The examiner opined that since the crystalline lens is an internal structure of the eye and not external, it is not likely that environmental hazards caused the condition since exposure on the crystalline lens would be minimum. Therefore, the examiner stated that it is not probable that nuclear sclerosis diagnosed on this Veteran was caused by environmental hazards while the Veteran was in service at Southwest Asia. After review, the Board finds that another VA examination is necessary as the VA examiner failed consider the Veteran's contention that the heat of the Southwest Asia region and sunlight created havoc with his eyesight. Here, although VA examiner expressed that nuclear sclerosis can be accelerated by excessive exposure to ultraviolet rays, the VA examiner did not opine as the whether the Veteran's sunlight exposure accelerated his nuclear sclerosis. As such, remand is required to afford the Veteran a new VA examination and medical opinion to determine the nature and etiology of his eye disorder. 2. Entitlement to service connection for sleep apnea is remanded. The Veteran is seeking service connection for sleep apnea. The Veteran was afforded a VA examination in June 2021. The Veteran was diagnosed with obstructive sleep apnea. The examiner opined that sleep apnea was less likely than not incurred in or caused by service. However, the examiner also expressed that obstructive sleep apnea is granted. In a July 2021 addendum opinion, the examiner stated that a sleep study dated in July 2019 confirmed a current diagnosis of severe obstructive sleep apnea. The examiner noted that according to the documentation, the psychiatrist documented that the Veteran had sleeping disturbances and snoring that affected his sleep cycle. The examiner opined that it is not likely (less than 50 percent probability) that any current or previously diagnosed sleep apnea was incurred in the Veteran's service. The examiner stated that according to the documentation, the psychiatrist documented that the Veteran had sleeping disturbances and snoring that affected his sleep cycle. The examiner noted that although snoring is a symptom of sleep apnea, there wasn't sufficient evidence to support that the condition was induced by the Veterans military service. After review, the Board finds that the examiner did not provide an adequate rationale for the negative finding other than finding there was wasn't sufficient evidence to support that the condition was induced by the Veterans military service. Therefore, the Board finds this opinion to be conclusory and unsupported by sufficient rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (a mere conclusory opinion is insufficient to allow the Board to make an informed decision as to the weight to assign to a medical opinion). As such, remand is required to afford the Veteran a new VA examination and medical opinion to determine the nature and etiology of his obstructive sleep apnea. 3. Entitlement to service connection for a vestibular disorder other than vertigo is remanded. The Veteran is seeking service connection for a vestibular disorder other than vertigo. The Veteran was afforded a VA examination in June 2016. The examiner diagnosed the Veteran with peripheral vestibular condition. In June 2018, the Board remanded the issue in order to obtain an addendum opinion that addresses entitlement to service connection for a vestibular disorder. Pursuant to the Board remand, the Veteran was afforded a VA examination in June 2021. The examiner indicated that the Veteran has not been diagnosed with an ear or peripheral vestibular condition. The examiner stated that the Veteran's claimed condition of a vestibular disorder other than vertigo is less likely than not (less than 50 percent probability) incurred in or caused by the Veteran's service as there is no objective evidence on the examination to support a vestibular disorder diagnosis. Thus, the examiner noted that a nexus cannot be established. In a July 2021 addendum opinion, the examiner expressed that the Veteran was previously diagnosed with vestibular disorder in 2016. The examiner noted that although the Veteran was previously diagnosed with a vestibular disorder in 2016, the examiner opined that it was not likely (less than 50 percent probability) that any current or previously diagnosed vestibular disorder other than vertigo was incurred in the Veteran's service. The examiner noted that the Veteran has a tinnitus type disorder that occasionally causes him a right ear buzzing sound that could be provoked by the artillery sounds but cannot be described as a vestibular disorder. After review, the Board finds that the VA examination and opinion are inadequate. With regard to the previously diagnosed vestibular disorder, the examiner merely stated that it was not related to service. The examiner failed to provide sufficient rationale. As such, the Veteran must be afforded another VA examination. 4. Entitlement to service connection for hypertension is remanded The Veteran is seeking service connection for hypertension. The Veteran was afforded a VA examination in June 2016. The Veteran was diagnosed with hypertension with the date of diagnosis in 2015. The examiner stated that hypertension is a disease with a clear and specific etiology and diagnosis that is less likely as not (less than 50/50 probability) caused by or a result of specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner noted that there is no evidence in medical literature of a direct etiologic relation between hypertension and previous exposure to environmental hazards the Veteran might have been exposed to during his deployment in Southwest Asia. Here the examiner's opinion and rationale are inadequate for making a determination for service connection in this case. The examiner did not discuss whether the Veteran's hypertension may be linked to his military service other than during his tour in Southwest Asia. In addition, the Veteran's service treatment records show that on his August 2006 pre-deployment health assessment, the Veteran's blood pressure was 125/89 and the examiner circled that the Veteran's blood pressure was over 135/85. Thus, the Board notes that the examiner did not reconcile his opinion with service treatment records documenting an elevated blood pressure reading. Furthermore, the Veteran's VA treatment records show continuous elevated blood pressure readings until the Veteran's diagnosis of hypertension. In September 2009, the Veteran had blood pressure readings of 142/79 and 128/82. In November 2009, the Veteran had a blood pressure reading of 142/84. As such, remand is warranted for ana VA examination that addresses whether the Veteran's hypertension manifested in service, within 1 year after service, or was continuous since service. 5. Entitlement to service connection for fibromyalgia (claimed as joint disorder) is remanded The Veteran is seeking service connection for fibromyalgia, claimed as a joint disorder. On his VA Form 9, the Veteran indicated that he has continuous unbearable pain in his back, knees, neck, and other parts of his body since service. In June 2016, the Veteran underwent a Gulf War examination. The examiner noted that there were no diagnosed illnesses for which no etiology was established. The examiner noted that the Veteran did not report any additional signs and/or symptoms not addressed through completion of Disability Benefits Questionnaire. No functional impact of additional signs and/or symptoms that may represent an "undiagnosed illness" or "diagnosed medically unexplained chronic multi symptom illnesses" was noted. After review, the Board finds that the examiner did not discuss the Veteran's underlying claim, unbearable joint pain, or fibromyalgia specifically. As a result, the Board finds this examination to be inadequate for the purposes of adjudication. As such, the Veteran should be afforded a new VA examination which takes into account all of the Veteran's enumerated symptoms to determine if he suffers from an undiagnosed illness or a diagnosed medically unexplained chronic multi symptom illness, to include fibromyalgia. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's bilateral eye disorder. The claims file, including a copy of this Remand, must be made available to, and reviewed by the examiner. All tests and studies deemed necessary by the examiner should be performed, and all clinical findings should be reported in detail. After a review of the record and an examination and interview of the Veteran, the examiner should offer an opinion as to the following: Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral eye disorder is related to an in-service injury, event, or disease, including exposure to to harsh desert climate as well as toxins in the air from the petroleum wells and burn pits. The examiner must address the Veteran's contention that sunlight and heat created havoc to his eyesight. The examiner must address whether the Veteran's nuclear sclerosis was accelerated by the Veteran's exposure to sunlight during service as indicated by the December 2016 VA examiner. The examiner must provide a complete rationale on which his/her opinion is based, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. 3. Schedule an appropriate VA medical examination to determine the nature and etiology of the Veteran's sleep apnea. The claims file, including a copy of this Remand, must be made available to, and reviewed by the examiner. All tests and studies deemed necessary by the examiner should be performed, and all clinical findings should be reported in detail. After a review of the record and an examination and interview of the Veteran, the examiner should offer an opinion as to the following: Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea is related to an in-service injury, event, or disease. Whether it is at least as likely as not that he Veteran's currently diagnosed sleep apnea was caused by his service-connected PTSD. Whether it is at least as likely as not that he Veteran's currently diagnosed sleep apnea was aggravated by his service-connected PTSD. The examiner must provide a complete rationale on which his/her opinion is based, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. 4. Schedule an appropriate VA medical examination to determine the nature and etiology of the Veteran's vestibular disorder. The claims file, including a copy of this Remand, must be made available to, and reviewed by the examiner. All tests and studies deemed necessary by the examiner should be performed, and all clinical findings should be reported in detail. After a review of the record and an examination and interview of the Veteran, the examiner should offer an opinion as to the following: Whether it is at least as likely as not (50 percent or greater probability) that any current or previously diagnosed vestibular disorder, other than vertigo is related to an in-service injury, event, or disease. The Board notes that the Veteran was previously diagnosed as a vestibular disorder. If the examiner finds that a diagnosis of a vestibular disorder is inappropriate, the examiner must reconcile that finding with the prior diagnosis of vestibular disorder found in the record. The examiner must provide a complete rationale on which his/her opinion is based, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. 5. Schedule an appropriate VA medical examination to determine the nature and etiology of the Veteran's hypertension. The claims file, including a copy of this Remand, must be made available to, and reviewed by the examiner. All tests and studies deemed necessary by the examiner should be performed, and all clinical findings should be reported in detail. After a review of the record and an examination and interview of the Veteran, the examiner should offer an opinion as to the following: Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension (1) began during active service, (2) manifested within 1 year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The examiner must discuss whether there is any association with the Veteran's current claimed hypertension and elevated blood pressure readings documented in service treatment records. The examiner must provide a complete rationale on which his/her opinion is based, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. 7. Schedule the Veteran for a VA examination, to include a Gulf War examination, to determine the nature and etiology of the Veteran's claimed joint pain. The examiner must review the entire claims file, to include a copy of this Remand, in conjunction with the examination. Based on this review of the record and examination, the examiner should provide opinions that respond to the following: Whether the symptoms relating to the Veteran's claimed joint pain is/are attributable to a known clinical diagnosis, including fibromyalgia. With respect to each diagnosis determined or identified for the Veteran's claimed joint pain, determine whether it is at least as likely as not (50 percent probability or greater) that the diagnosed disease, disability or symptoms were: 1) an undiagnosed illness; or 2) medically unexplained chronic multisystem illness (MUCMI); or 3) diagnosable chronic multi-symptom illness with a partially explained etiology; or 4) is a disease with a clear and specific etiology and diagnosis. The examiner is informed that a MUCMI means a diagnosed illness without conclusive pathophysiology or etiology, characterized by certain overlapping symptoms and signs, and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. MUCMIs of partially understood etiology and pathophysiology will not be considered "medically unexplained." See 38 C.F.R. § 3.317. With respect to each diagnosis for joint pain, if the diagnosis is not considered a MUCMI, determine whether it is at least as likely as not (50 percent probability or higher) that the Veteran's joint pain began during or is etiologically related to the Veteran's active-duty service. The examiner must provide a complete rationale on which his/her opinion is based, and must include a discussion of the medical principles as applied to the medical evidence and facts used in establishing his or her opinion. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M.D. 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.