Citation Nr: 21075853 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-33 815 DATE: December 21, 2021 ORDER Service connection for sleep apnea is granted. REMANDED Entitlement to a rating in excess of 50 percent for post-traumatic stress disorder (PTSD) is remanded. Service connection for erectile dysfunction is remanded. FINDING OF FACT The Veteran's sleep apnea had its onset in service. CONCLUSION OF LAW The criteria for service connection for sleep apnea have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from June 1996 to February 1997 and from February 2003 to March 2004 with service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that a claim for a total disability rating based on individual unemployability (TDIU) is part of an increased rating claim when such claim is raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). However, here the evidence reveals that the Veteran is employed and that he has not reported that his service-connected disability on appeal precludes substantially gainful employment. See Medical Treatment Record, April 2020. Therefore, the issue of entitlement to a TDIU is not before the Board. 1. Service connection for sleep apnea. The Veteran seeks service connection for sleep apnea, which he relates to trouble sleeping and snoring since service. Alternatively, the Veteran asserts that his sleep apnea is secondary to his PTSD and/or weight gain due to his service-connected disabilities. Post service treatment records show a diagnosis of sleep apnea in October 2006 and the Veteran was prescribed a CPAP machine for management of his condition. See VA Examination, September 2015. Medical treatment records and lay statements show that the Veteran has reported trouble sleeping and snoring. See Medical Treatment Records, July 2004, December 2011, and June 2016; see also VA Examination, September 2015 (noting reports of not sleeping well and snoring during service). The Veteran is competent to report the onset and continuation of his sleep apnea symptoms and the Board finds his testimony credible. See Charles v. Principi, 16 Vet. App. 370, 374 (2002); see also Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Here, in light of the competent and credible lay evidence, the Board finds that the disease process of the Veteran's obstructive sleep apnea became manifest while he was on active duty. Further, the evidence shows that he has been diagnosed as having this disability. In reaching this decision, the Board acknowledges that in September 2015 and July 2017, a VA examiner provided a negative nexus opinion regarding the etiology of the Veteran's sleep apnea. Critically, however, these examinations are minimally probative as to whether the Veteran's sleep apnea had onset in service as they impermissibly fail to address the competent, credible evidence of symptoms in and since service. As such, the Board concludes that the evidence shows that the disability became manifest while the Veteran was on active duty and thus was incurred in service. 38 C.F.R. § 3.303(a); see Flynn v. Brown, 6 Vet. App. 500, 503 (1994). Given the grant of direct service connection, the Board need not address secondary service connection, or any other theories for service connection, in this matter. REASONS FOR REMAND 1. Entitlement to a rating in excess of 50 percent for post-traumatic stress disorder (PTSD) is remanded. In a November 2021 Third Party Correspondence, the Veteran, through his representative, asserts that his PTSD is worse than contemplated by the 50 percent disability rating and requests an updated VA examination. As the Veteran is both competent and credible to report his symptoms and the most recent VA examination is from April 2016, the Board finds that a remand is necessary to afford the Veteran a new VA examination to determine the current severity of his service-connected disability. See Snuffer v. Gober, 10 Vet. App. 400 (1997); VAOPGCPREC 11-95 (1995). 2. Service connection for erectile dysfunction is remanded. The Veteran asserts that his erectile dysfunction is secondary to his service-connected PTSD. See Third Party Correspondence, November 2021. As the examination of record only discussed a relationship between erectile dysfunction and chronic fatigue syndrome, the Board finds remand necessary to obtain a new opinion addressing all of the Veteran's contentions. The matters are REMANDED for the following action: 1. Obtain any outstanding VA records. 2. Schedule the Veteran for an appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the current nature and severity of his PTSD. The claims file should be made available and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. The examiner must specifically acknowledge and discuss any reports by the Veteran pertaining to the severity of his symptoms. 3. Obtain an addendum opinion to determine the nature, onset, and etiology of the Veteran's erectile dysfunction. It is left to the examiner's discretion whether to schedule the Veteran for an in-person examination (or telehealth interview, records review, etc., if an in-person examination is not feasible) for the above listed disabilities. The examiner must opine as to whether it is at least as likely as not that the Veteran's erectile dysfunction is related to the Veteran's service-connected disabilities, to include PTSD and fibromyalgia, or is otherwise related to the Veteran's period of service. In offering these opinions, the examiner must acknowledge and discuss the competent lay evidence of record. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sara Leigh, Attorney Advisor 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.