Citation Nr: 21074607 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 19-13 381 DATE: December 15, 2021 REMANDED The claim of entitlement to service connection for benign prostatic hyperplasia (BPH), to include as secondary to posttraumatic stress disorder (PTSD) and sleep apnea, is remanded. The claim of entitlement to a total disability rating based on individual unemployability (TDIU) prior to December 4, 2019, is remanded. REASONS FOR REMAND The Veteran had honorable active duty service in the United States Navy from June 1968 to July 1988. He received the Vietnam Service Medal, among other notable commendations. These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2021, the Board issued a decision remanding the matter of entitlement to service connection for BPH, which it framed to include as secondary to PTSD and sleep apnea, noting that the medical opinion evidence of record was inadequate. Specifically, a December 2017 examination report did not address the Veteran's in-service treatment of urethral discharge and prostatitis. See May 1971 service treatment records (STRs). Further, regarding secondary service connection, the medical opinion failed to address both causation and aggravation. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). On remand, the RO requested opinions regarding whether "the Veteran's [BPH], to include as secondary to PTSD and sleep apnea" was at least as likely as not due to, the result of, or aggravated beyond its natural progression by the Veteran's PTSD with major depressive disorder (also claimed as anxiety and insomnia)." Each of the completed opinions addressed only whether the Veteran's BPH was due to or worsened by the Veteran's PTSD and did not clearly address whether the BPH was due to or worsened by the Veteran's separately connected sleep apnea condition. While the Board acknowledges that the remand directives did not specifically mention sleep apnea, the Board finds in this case that an addendum opinion is necessary to adequately address secondary service connection for BPH due to sleep apnea given the broad framing of the claim on appeal, the Veteran's lay contentions regarding "insomnia," and the fact that the Veteran's sleep apnea is service-connected independent of his PTSD. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Next, as determined in the May 2021 Board decision, the issue of entitlement to a TDIU is inextricably intertwined with the BPH claim and must be remanded as well. The Board highlights for procedural clarity (as summarized in the May 2021 remand) that although the Veteran has filed a supplemental claim for an effective date earlier than December 4, 2019 for the TDIU, because the TDIU was raised by the record as part of the Veteran's claim for an increased disability rating but was not granted for the entire appeal period, it has remained pending on appeal before the Board. This appeal has been advanced on the Board's docket pursuant to 38 U.S.C. § 7107(a)(2) and 38 C.F.R. § 20.902(c). 1. The claim of entitlement to service connection for BPH, to include as secondary to PTSD and sleep apnea, is remanded. As outlined above, the Veteran contends entitlement to service connection for BPH, to include as secondary to service-connected PTSD or sleep apnea. Remand is necessary as the medical opinion evidence has not addressed whether the Veteran's BPH was caused or aggravated by his service-connected sleep apnea condition, which is rated as 50 percent disabling. 2. The claim of entitlement to a TDIU prior to December 4, 2019, is remanded. Consideration of entitlement to a TDIU is dependent upon the impact of service-connected disabilities on a Veteran's ability to obtain or retain substantially gainful employment. The matter of a TDIU is therefore inextricably intertwined with the claim on appeal and must be remanded as well. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. These matters are advanced on the Board's docket. 2. Arrange for an appropriate examiner to review the Veteran's claims file and provide an addendum opinion as to the issue of service connection for the Veteran's BPH as secondary to the Veteran's sleep apnea. If the examiner feels an in-person or video telehealth examination is necessary, another examination should be scheduled. The examiner should provide an opinion addressing the following: (a.) Is the Veteran's BPH at least as likely as not (50 percent probability or greater) (1) caused or (2) aggravated beyond its natural progression by his service-connected sleep apnea? Aggravation means an increase in disability any additional impairment of earning capacity of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. The clinician must provide a reasoned medical rationale for the opinion, considering all relevant lay and medical evidence of record. 3. Following completion of the above, the Agency of Original Jurisdiction (AOJ) should review the record, ensure adequacy of the medical opinions supplied and readjudicate the claims on appeal. If either claim remains denied, the AOJ should issue an appropriate supplemental Statement of the Case, afford the Veteran and his representative an opportunity to respond, and return the case to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, Associate 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.