Citation Nr: 21076900 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 18-09 343 DATE: December 28, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Coast Guard from January 1982 to December 1982. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. In July 2021, the Veteran testified at a virtual Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. Entitlement to service connection for sleep apnea is remanded. The Veteran seeks to establish service connection for sleep apnea. He believes that his sleep apnea is related to nasal symptoms that are, in turn, associated with exposures he experienced during the daily stripping and repainting of a boat over the course of several months during service. A statement from fellow service member attests to the fact that the Veteran painted and removed paint from a ship, that the paint used on the vessel was lead-based, that he did not have any breathing protection other than a t-shirt or some type of cloth, and that he would cough up and sneeze the dust he breathed in. The evidence of record shows that the Veteran has been diagnosed with sleep apnea. In November 2017, a former VA otolaryngologist concluded that it was more likely than not that the Veteran had a persistent nasal obstruction (turbinate hypertrophy) that was a "direct effect" of aerosolized lead exposure he experienced while stripping a boat of lead paint during service. The examiner observed, in part, that prolonged exposure to dust particles can pose likely risks, including respiratory illnesses, that the Veteran began to suffer from nasal obstruction during service, and that he had nasal mucosal inflammation that was more than what would be expected even in the presence of allergic rhinitis. In July 2021, the same otolaryngologist further found that the Veteran's nasal obstruction condition contributed to his sleep apnea. Unfortunately, the report contains no explanation for the physician's conclusion in that regard. As such, the report is insufficient to support an award of service connection. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) ("it is the factually accurate, fully articulated, sound reasoning for the conclusion . . . that contributes probative value to a medical opinion"). The Veteran has not been afforded a VA examination in connection with his claim. VA must provide an examination when there is competent evidence of a disability (or persistent or recurrent symptoms of a disability) that may be associated with an in-service event, injury, or disease, but there is insufficient information to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). Although not an adequate basis for a grant of benefits, the diagnosis, lay assertions, and medical opinions currently of record suggest that the Veteran's sleep apnea "may be associated" with service. As such, an examination and opinion are warranted. As a final matter, the Board notes the Veteran's testimony to the effect that he legally changed his surname some years ago. Presently, his VA claims file doesn't contain any formal documentation of that change, such as a copy of a court order. If the Veteran would like to have his current surname formally recognized by VA, he should submit appropriate documentation for the record. This matter is REMANDED for the following action: 1. Inform the Veteran that if he would like to have his current surname formally recognized by VA, he needs to submit formal documentation of the name change, such as a copy of a court order approving the change. 2. Obtain copies of records pertaining to any VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159. The evidence obtained, if any, should be associated with the record. 3. Arrange to have the Veteran scheduled for a VA examination of his sinuses. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to whether the Veteran has had a nasal obstruction at any time since October 2016 (when he filed his claim for service connection) and, if so, whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the nasal obstruction had its onset in, or is otherwise attributable to, the Veteran's period of active service, to include as a result of exposure to aerosolized materials, including lead, from the stripping and repainting of a boat over the course of several months during service. In so doing, the examiner should discuss the lay statements of record as to the exposures the Veteran experienced during service and the November 2017 medical opinion from a former VA otolaryngologist to the effect that it is likely that the Veteran has a persistent nasal obstruction (turbinate hypertrophy) that is a "direct effect" of aerosolized lead exposure he experienced while stripping a boat of lead paint during service. A complete medical rationale for all opinions expressed must be provided. 4. Also arrange to have the Veteran scheduled for a VA examination for sleep apnea. The examiner should review the record. All indicated tests should be conducted and the results reported. After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's sleep apnea had its onset in, or is otherwise attributable to, his period of active service. If it is the examiner's opinion that it is unlikely that the Veteran's sleep apnea had its onset in, or is otherwise attributable to, service, the examiner should offer a further opinion as to whether it is at least as likely as not that such disability has been (a) caused or (b) aggravated (i.e., permanently or temporarily worsened beyond natural progression) by any nasal obstruction that has been identified since October 2016 (when he filed his claim for service connection). In so doing, the examiner should consider and discuss the July 2021 opinion from a former VA otolaryngologist to the effect that the Veteran has a nasal obstruction condition that contributes to his sleep apnea. A complete medical rationale for all opinions expressed must be provided. 5. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joseph T. Leonard, 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.