Citation Nr: 21014324 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 18-17 623 DATE: March 11, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for diarrhea is remanded. Entitlement to service connection for skin rash on both eyelids is remanded. REASONS FOR REMAND The Veteran had active military service from August 1989 to October 1991, from July 1998 to February 1999, and from October 2007 to May 2008; his service included being in the Southwest Asia theater of action during the Persian Gulf War. He testified before the undersigned Veterans Law Judge during an August 2020 hearing. This matter is on appeal from February 2015, April 2015, and June 2015 rating decisions. 1. Entitlement to service connection for sleep apnea is remanded. The Board of Veterans’ Appeals (Board) cannot make a fully-informed decision on the issue of service connection for sleep apnea because no VA examiner has provided an opinion addressing the Veteran's testimony of sleep apnea beginning during service. The Veteran was provided a VA examination in January 2015; a negative nexus opinion was provided. Part of the rationale is that the Veteran's service treatment records (STRs) were silent for any sleep apnea condition. However, the Veteran has reported having sleep apnea symptomatology during service. Further, the absence of evidence is not a sufficient rationale for a negative nexus opinion. Remand is necessary for an addendum opinion addressing his assertions. 2. Entitlement to service connection for diarrhea is remanded. The Board cannot make a fully-informed decision on the issue of service connection for diarrhea because no VA examiner has provided an opinion addressing the Veteran’s testimony of his chronic diarrhea beginning during service. The Veteran was provided a VA examination in January 2015; no diagnosis was rendered, and a negative nexus opinion was provided. Part of the rationale is that the Veteran did not have a current intestinal condition/diagnosis. A VA treatment record in March 2018 shows that the Veteran reported having severe diarrhea for more than 20 years. Remand is necessary for a new examination to determine if the Veteran has a current diagnosis, and whether his chronic diarrhea is related to service. 3. Entitlement to service connection for skin rash on both eyelids is remanded. The Board cannot make a fully-informed decision on the issue of service connection for skin rash on both eyelids because no VA examiner has provided an opinion addressing the Veteran’s testimony of his rash beginning during service. The Veteran was provided a VA examination in January 2015; a negative nexus opinion was provided. Part of the rationale is that the Veteran’s STRs were silent for any seborrheic dermatitis condition. However, the Veteran has reported having a rash during service. Also, the absence of evidence is not a sufficient rationale for a negative nexus opinion. Remand is necessary for an addendum opinion addressing his assertions. The matters are REMANDED for the following action: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran, including any outstanding VA treatment records. 2. Obtain an addendum medical opinion from the January 2015 VA sleep apnea and skin diseases examiner (or, if unavailable, from a medical professional with appropriate expertise) to determine the etiology of the diagnosed sleep apnea and seborrheic dermatitis. The examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed sleep apnea and seborrheic dermatitis are related to the Veteran's military service, to include being due to an undiagnosed illness (i.e., is chronic in nature but not attributable to a known clinical diagnosis). The examiner must consider the Veteran’s August 2020 testimony regarding his sleep apnea and seborrheic dermatitis beginning during service. The examiner is reminded that the absence of evidence is not a sufficient rationale for a negative nexus opinion. A complete rationale should be given for all opinions and conclusions expressed. 3. Schedule the Veteran for a VA examination by an appropriate clinician to determine the etiology of any diagnosed disorder manifested by chronic diarrhea. The most up-to-date Disability Benefits Questionnaire(s) should be utilized. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. For any disorder manifested by chronic diarrhea, the examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosis is related to the Veteran’s military service, to include being due to an undiagnosed illness (i.e., is chronic in nature but not attributable to a known clinical diagnosis). The examiner must consider the Veteran’s August 2020 testimony regarding his diarrhea beginning during service. The examiner is reminded that the absence of evidence is not a sufficient rationale for a negative nexus opinion. A complete rationale should be given for all opinions and conclusions expressed. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Barstow, 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.