Citation Nr: A21019093 Decision Date: 12/01/21 Archive Date: 11/30/21 DOCKET NO. 191129-52021 DATE: December 1, 2021 REMANDED Service connection for restless leg syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1990 to February 1993. The Department of Veterans Affairs (VA) is grateful for his service. On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (to be codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. This appeal arises from the Veteran's timely appeal of an Agency of Original Jurisdiction (AOJ) October 2019 rating decision with election of the Board of Veterans' Appeals (Board) hearing docket. Based on this election, the Board may consider the evidence of record at the time of the AOJ decision on appeal, additional evidence submitted on the date of the July 2021 Board hearing (including testimony), and additional evidence submitted within 90 days of the hearing. 38 U.S.C. § 7113 (b). Regrettably, failure of the duty to assist based on inadequate examinations, as detailed below, necessitates remand development. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159 (c). Service connection for restless leg syndrome is remanded. The Veteran contends, in effect, that he has restless leg syndrome due to exposures while stationed in Southwest Asia during the Persian Gulf War, or as a result of his service-connected posttraumatic stress disorder (PTSD) or medications for treatment of his PTSD. At his July 2021 hearing before the undersigned, the Veteran testified to having ongoing symptoms of restless leg syndrome, and receiving treatment exclusively through VA. Upon VA examination in May 2019, the Veteran reported that he had restless legs that interfered with his sleep and resulted his never feeling rested. In July 2019 the examiner provided an opinion that the Veteran's restless leg syndrome was not at least as likely as not (less than 50 percent probability) due to or the result of the Veteran's service-connected PTSD. To support this opinion, the examiner noted that the Veteran was diagnosed with severe periodic movement disorder, or restless leg syndrome, and that reviewed medical literature support the fact that there was no known cause of restless leg syndrome. Noted risk factors were reviewed, and these were not noted to include PTSD or other psychiatric disability or medications for treatment of psychiatric disability. Regrettably, the examination opinion is inadequate because it failed to address the question of aggravation of the Veteran's restless leg syndrome by his PTSD or its treatment. See Allen v. Brown, 7 Vet. App. 439 (1995). Secondary aggravation must be addressed upon remand examination. Upon a VA examination in September 2019, the examiner noted that the Veteran had served in Southwest Asia during the Persian Gulf War, but opined that it was not at least as likely as not (less than 50 percent probability) that the Veteran's restless leg syndrome was caused by an exposure event in Southwest Asia. The examiner also informed that restless leg syndrome was a condition with a clear and specific etiology and diagnosis. Hence, the condition cannot be characterized as a Gulf War undiagnosed illness. The September 2019 examiner observed that the Veteran was currently diagnosed with restless leg syndrome, whereas under a sleep study performed in November 2017 the Veteran was diagnosed with periodic limb movement disorder. The examiner then noted that both of these were "classified under (nocturnal) myoclonus, which describes frequent or involuntary muscle spasms," and she further explained, "Experience of these disorders is less likely than not caused by the Veteran's exposure event in Southwest Asia theater of operations." The Board does not find the September 2019 examiner's rationale adequate because it provides no medical explanation, beyond restating the conclusion in the Veteran's specific case, for the Veteran's restless leg syndrome not being causally associated with exposures in the Southwest Asia theater of operations. This necessitates an addendum or new examination. Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007); Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following action: Obtain addenda or new examinations by qualified examiners to address the Veteran's claimed restless leg syndrome and questions of a causal link to environmental exposures while stationed in Southwest Asia during the Persian Gulf War, and of aggravation by service-connected PTSD or its medical treatment. The claims file must be reviewed, and any necessary tests or studies should be conducted. The examiner is to be advised that prior examination reports were inadequate because the question of aggravation by PTSD was not answered, and an adequate rationale for the opinion against a causal link to environmental exposures while stationed in Southwest Asia during the Persian Gulf War was not provided. a. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's restless leg syndrome is causally related to environmental exposures while stationed in Southwest Asia during the Persian Gulf War. b. The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's restless leg syndrome was aggravated (worsened) by his PTSD or by treatment for his PTSD including medications taken for his PTSD. Aggravation under 38 C.F.R. § 3.310 (b) does not require that there be "permanent" worsening of the nonservice connected disability. An adequate rationale (explanation supported by evidence and medical knowledge) must be provided for all opinions. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Schechter 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.