Citation Nr: 21077057 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 17-32 303 DATE: December 28, 2021 . REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection of sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1981 to April 1984. In October 2018, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In March 2019 and April 2021, the Board remanded the issues on appeal for additional development. 1. Entitlement to service connection for a cervical spine disability is remanded. 2. Entitlement to service connection of sleep apnea is remanded. Unfortunately, the Board finds that further AOJ action on the claims on appeal is warranted, even though such will, regrettably, further delay an appellate decision on the matters on appeal. As noted in the Board's previous remands, the Veteran contends that his current cervical spine disability, diagnosed as degenerative disc disease, originates from an in-service neck injury. He also contends that his sleep apnea first developed in service. At his Board hearing, he testified (along with his spouse) that he has had ongoing neck and sleep-related symptoms since his discharge from service. He described an incident in service in which he appeared to fall asleep while driving a car, which he attributed to sleep apnea. His service treatment records also note problems with insomnia. He also testified that while serving in Germany he sometimes experienced pain and stiffness in his neck, which he self-treated with rest and aspirin, and that he experienced locking and pain in the neck once or twice per year beginning shortly after his separation. In March 2019 and April 2021, the Board instructed the Agency of Original Jurisdiction (AOJ) to schedule the Veteran for VA examinations to evaluate his claims. In particular, the Board directed examiners to provide nexus opinions with consideration of the Veteran's lay assertions in support of his claims. Regarding the Veteran's cervical spine disability, the Board directed the examiner to "specifically discuss the Veteran's testimony (which can be found in his Board hearing transcript) that he sustained a neck injury in service with fairly regular neck pain and locking thereafter, up to the present day." As to the Veteran's sleep apnea, the Board similarly directed an examiner to "discuss the Veteran's testimony (provided at his Board hearing) that he experienced sleeping problems in service, including one incident where he claimed to have fallen asleep while driving," as well as "the Veteran's reports of insomnia in service." In response, the AOJ afforded the Veteran examinations in November 2019 and July 2021, after which the examiners provided negative nexus opinions regarding both claimed disabilities. Unfortunately, the Board finds that these opinions are inadequate. On review, both opinions rely largely on the lack of documentation of sleep-or neck-related symptoms in service. In addition, there is no substantive discussion of the Veteran's contentions, to include his descriptions of in-service symptoms, as specifically instructed by the Board in previous remand directives. As such, addendum opinions are warranted to ensure VA's duty to assist the Veteran is satisfied. See Buchanan v. Nicholson, 451F.3d 1331, 1336 (Fed. Cir. 2006) (noting lay evidence concerning the onset of symptoms, if credible, is competent, regardless of the lack of contemporaneous medical evidence); Stegall v. West, 11 Vet. App. 268, 271(1998) (holding that a Board remand confers upon claimants, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand). The matters are REMANDED for the following action: 1. The AOJ should refer the electronic claims file to an appropriate medical professionalother than the 2021 examinerfor addendum opinion pertaining to the claimed cervical spine disability, to include degenerative joint disease. If another examination is deemed necessary, one should be provided. The clinician must opine whether it is at least as likely as not that such disability was incurred in or is otherwise related to service. The examiner is also advised that the Veteran is competent to report symptoms and treatment, and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinions. THE CLINICIAN MUST SPECIFICALLY DISCUSS THE VETERAN'S TESTIMONY (which can be found in his Board hearing transcript) THAT HE SUSTAINED A NECK INJURY IN SERVICE WITH FAIRLY REGULAR NECK PAIN AND "LOCKING" THEREAFTER, UP TO THE PRESENT DAY. A detailed rationale must be included in support of all opinions provided. 2. The AOJ should also refer the electronic claims file to an appropriate medical professionalother than the 2021 examinerfor addendum opinion pertaining to the claimed sleep apnea. If another examination is deemed necessary, one should be provided. The clinician must opine whether it is at least as likely as not that such disability was incurred in service, or is otherwise related to service. The examiner is also advised that the Veteran is competent to report symptoms and treatment, and that his reports must be taken into account, along with the other evidence of record, in formulating the requested opinions. THE CLINICIAN MUST SPECIFICALLY DISCUSS THE VETERAN'S TESTIMONY (which can be found in his Board hearing transcript) THAT HE EXPERIENCED SLEEPING PROBLEMS, INCLUDING ONE INCIDENT WHEN HE CLAIMED TO HAVE FALLEN ASLEEP WHILE DRIVING. THE CLINICIAN MUST ALSO DISCUSS THE VETERAN'S REPORTS OF INSOMNIA IN SERVICE. A detailed rationale must be included in support of all opinions provided. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. E. Wilkerson, 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.