Citation Nr: 21075634 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 20-04 529 DATE: December 21, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for post thoracotomy pain syndrome, left shoulder and chest, with ipsilateral pain is remanded. Entitlement to a rating greater than 10 percent for tender long thoracotomy scar with cross shaped scar and additional scars is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from March 1966 to March 1970, including foreign service. For his meritorious service, the Veteran was awarded (among other decorations) the Air Force Medal. Although the Board sincerely regrets the additional delay this will cause, further development is necessary prior to the adjudication of these appeals. As to the sleep apnea claim, an August 2014 VA examiner offered a negative nexus opinion upon concluding that current literature did not support a secondary link between the claimed condition and the Veteran's service-connected pneumothorax residuals. The Veteran has since provided multiple articles indicative of such a link, in addition to statements which raise additional theories of entitlement. See, e.g., March 2021 VA back and psychiatric examinations. Thus, an addendum opinion is required. As to the pain syndrome and scar claims, an August 2014 VA shoulder examiner concluded that the Veteran's pain was likely attributable to non-service-related arthritis. However, an August 2014 VA muscle examiner noted the Veteran's history of an in-service pneumothorax and reported a current injury to the left thoracic muscle group (group XXI). A March 2021 VA scar examiner similarly reported muscle pain, but then declined to diagnose muscle or nerve damage related to the service-connected disability. Thus, these matters must be remanded for clarification on this point. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion addressing the questions below. The claims file and a copy of this remand must be made available for review, and the examination report must reflect that review of the claims file occurred. In particular, the sleep apnea examiner should offer opinions as to the following: (a.) Is it at least as likely as not that the Veteran's sleep apnea began in service, was caused by service, or is otherwise related to service, including an in-service pneumothorax and related treatment? Here, the examiner must address an August 2015 buddy statement regarding the Veteran's in-service symptoms and a series of articles addressing the link between sleep apnea and pneumothorax. (c.) Is it at least as likely as not that the disorder was caused or aggravated by the Veteran's service-connected back, psychiatric, or pneumothorax disabilities or the treatment thereof? Again, the examiner must address the academic articles provided by the Veteran addressing the link between sleep apnea and pneumothorax, and a series of VA examinations regarding possible secondary links in this case. The pain syndrome examiner should offer opinions as to the following: (a.) Has the Veteran demonstrated a post thoracotomy pain syndrome of the left shoulder and chest at any time during the period on appeal? In doing so, the examiner must account for the Veteran's competent reports of symptoms and a documented injury to muscle group XII. (b.) If so, is it at least as likely as not that the condition began in service, was caused by service, or is otherwise related to service, including an in-service pneumothorax and related treatment? (c.) Is it at least as likely as not that the disorder was caused or aggravated by the Veteran's service-connected pneumothorax disability or the treatment thereof? A complete rationale should be provided for all opinions or conclusions expressed. It should be noted that the Veteran is competent to attest to observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 2. Schedule the Veteran for a VA examination to assess the current severity of his service-connected scar. The claims folder must be provided to the examiner in conjunction with the examination. All necessary tests and studies should be conducted. The examiner should offer an assessment of all pertinent symptomatology and findings, to be reported in detail in accordance with Diagnostic Code 7805. The examiner must also address how many scars are shown by the Veteran as related to his in-service pneumothorax treatment, and whether he presents with any underlying muscle damage/condition as a result thereof. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.