Citation Nr: 21012010 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 18-38 083 DATE: March 3, 2021 REMANDED Entitlement to service connection for a joint condition, to include vitamin deficiency, is remanded. Entitlement to service connection for a sleep disorder, to include sleep apnea, insomnia, and fatigue, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1981 to June 1991, including service in the Persian Gulf from August 1990 to March 1991. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) wherein the RO adjudicated the Veteran’s December 19, 2014, claim. A hearing was held before the undersigned Veterans Law Judge (VLJ) in January 2021. \ Entitlement to service connection for a joint condition, to include vitamin deficiency, and for a sleep disorder, to include sleep apnea, insomnia, and fatigue, is remanded. As an initial matter, the Board notes that the RO characterized the Veteran’s claims as entitlement to service connection for a vitamin D deficiency and entitlement to service connection for sleep apnea. However, in Clemons v. Shinseki, the United States Court of Appeals for Veteran’s Claims (Court) held that, in determining the scope of a claim, the Board must consider the claimant’s description of the claim; symptoms described; and the information submitted or developed in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In light of the Court’s decision in Clemons, the Board has re-characterized the issues as stated on the title page. The Veteran asserts that his claimed conditions are etiologically related to his active duty service, specifically his service in Southwest Asia and exposure to burn pits during Gulf War service. The Board notes that the VA must adjudicate all theories of entitlement reasonably raised by the record. See Robinson v. Peake, 21 Vet. App. 545 (2008); see also Roebuck v. Nicholson, 20 Vet. App. 307 (2006). In a July 2018 Form 9, the Veteran asserted that his claimed conditions may be related to burn pit exposure while servicing in the Southwest Asian theater of operations during the Gulf War. While the Veteran received VA examinations for his claimed vitamin D deficiency and claimed sleep apnea, an opinion has not yet been provided as to the possibility of a relationship between his claimed conditions and burn pit exposure. Thus, a remand for a medical opinion is warranted for the claimed conditions. See Robinson; see also McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The Veteran testified that he has had sleep problems since service, and that he also has suffered from fatigue since that time. He also reported that he was unaware of the diagnosis of obstructive sleep apnea until many years after his discharge from active duty. Further, on remand the Veteran should be asked to provide additional information regarding his service in Southwest Asia and his claimed symptomatology. The matters are REMANDED for the following action: 1. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of any joint, vitamin, or sleep-related problems, including fatigue, as well as any additional information relating to his reported service in the Persian Gulf. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 2. Afford the Veteran a VA examination(s) to address the nature and etiology of his claimed joint condition, to include a vitamin deficiency, and his claimed sleep disorder, to include sleep apnea, insomnia, and fatigue. The record must be made available to and be reviewed by the examiner. A diagnosis of obstructive sleep apnea and of chronic fatigue syndrome must be ruled in or excluded. Thereafter, the examiner is to: (a) Please state whether the symptoms of each claimed condition are attributable to a known clinical diagnosis. If the Veteran does not now have, but previously had any such condition, when did that condition resolve? (b) Is the Veteran’s disability pattern consistent with: (1) a diagnosable but medically unexplained chronic multisymptom illness of unknown etiology, (2) a diagnosable chronic multisymptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis. (c) If, after examining the Veteran and reviewing the claims file, you determine that the Veteran’s disability pattern is either (2) a diagnosable chronic multi-symptom illness with a partially explained etiology, or (3) a disease with a clear and specific etiology and diagnosis, then please provide an expert opinion as to whether it is related to a presumed environmental exposures experienced by the Veteran during service in Southwest Asia. (d) Is it at least as likely as not that any diagnosed disorder or functional impairment had its onset directly during the Veteran’s service or is otherwise causally related to any event or circumstance of his service, including environmental exposures during service in Southwest Asia during the Persian Gulf War? (e) If not directly related to service on the basis of questions (b)-(d), is any medical condition or functional impairment proximately due to, the result of, or caused by any service-connected disability(ies)? (a.) (f) If not caused by another medical condition, has any disorder or functional impairment been aggravated by any service-connected disability(ies)? In answering all questions (a) to (f), please articulate the reasons underpinning your conclusions. That is, (1) identify what facts and information, whether found in the record or outside the record, support your opinion, and (2) explain how that evidence justifies your opinion. Please note that the Veteran is competent to report the onset and recurrence of his symptoms. The examiner must provide a rationale for all opinions expressed. If the examiner is unable to provide any required opinion, the examiner should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, a complete explanation as to why this is so should be provided. If the inability to provide a more definitive opinion is the result of a need for additional information, the additional information that is needed should be identified. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Gorum, 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.