Citation Nr: 21015011 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 16-38 808 DATE: March 16, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for colon ulcers with hole is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1982 to July 2002, to include service in Southwest Asia. This case comes to the Board of Veterans’ Appeals (Board) on appeal from December 2013 and January 2015 Regional Office (hereinafter “RO” or “AOJ”) rating decisions. By a February 2019 decision, the Board denied the Veteran’s claims for entitlement to service connection for migraines and sleep apnea; it also granted an increased rating of 50 percent for the Veteran’s service-connected PTSD. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). The Veteran’s representative and the VA Office of General Counsel filed a Joint Motion for Remand, requesting that the Court vacate the Board’s decision and remand the case to the Board for further development and readjudication. In a December 20, 2019 Order, the Court granted the Joint Motion. The case was returned to the Board. In May 2020, the Board remanded the case to the AOJ. The AOJ granted the Veteran’s service connection claim for migraine headaches. Therefore, that issue is no longer on appeal. The Veteran’s sleep apnea and PTSD claims have been returned to the Board; however, for the reasons outlined below, a remand of those issues is necessary. The February 2019 Board opinion also remanded the issue of service connection for colon ulcers. For the reasons outlined below, a remand of that issue is also necessary. 1. Entitlement to service connection for obstructive sleep apnea is remanded. The Veteran received a VA sleep apnea examination in June 2020. The examiner, Dr. D.M.C., issued a negative nexus opinion. Unfortunately for the Veteran, however, the opinion offered by Dr. D.M.C. was inadequate in its reasoning. The supporting statements were conclusory and lacked adequate detail with regarding to etiology. The examiner merely reasoned that “there is an absence of supporting medical evidence that the [V]eteran’s obstructive sleep apnea is caused by PTSD with medication use.” The examiner also failed to discuss the Veteran’s statement that his sleep apnea had its onset in 1991 and that “[h]e was on the front lines” when the apnea started. Therefore, an addendum opinion is needed. 2. Entitlement to a rating in excess of 50 percent for PTSD is remanded. The Veteran’s last comprehensive PTSD evaluation took place in February 2017. The Veteran has received VA medical treatment since then. Pursuant to the Board’s May 2020 remand instructions, his treatment records have been associated with the file. However, in a September 2020 brief, the Veteran’s representative suggested that the Veteran’s psychiatric disability may have worsened since his 2017 examination. Given that the last examination occurred over four years ago, the Board finds that a new examination is warranted. 3. Entitlement to service connection for colon ulcers with hole is remanded. In response to a February 2019 Board remand, the Veteran received a VA gastrointestinal examination in October 2019. The examiner issued a negative nexus opinion. Unfortunately for the Veteran, however, the opinion was inadequate in its reasoning. The supporting statements were conclusory, failed to address the 2009 diagnosis of acute diverticulitis, failed to address the existence of any current ulcer symptoms, conflated discussions of GERD symptoms and abdominal ulcer symptoms, and also failed to address (with adequate particularity) the etiology of the 2009 diverticulitis diagnosis. Furthermore, additional medical records have been associated with the record and need to be reviewed for indications that the Veteran’s service-connected disabilities may be related to his gastrointestinal symptomatology. In light of the foregoing, the Board finds a new medical opinion is needed. The matters are REMANDED for the following action: 1. Obtain copies of records pertaining to any relevant 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. 2. After the foregoing development has been completed to the extent possible, obtain an addendum opinion pertaining to the Veteran’s sleep apnea. The examiner should review the record. If possible, the examiner should be an individual other than the provider who issued the June 2020 opinion. 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 sleep apnea had its onset in, or is otherwise attributable to, the Veteran’s period of active service. In so doing, the examiner should discuss the Veteran’s reports that his sleep apnea symptoms began in service. Specifically, the examiner should discuss the Veteran’s symptoms that have been noted to begin in 1991 and during combat in the Gulf War. The examiner should also discuss the effects of any medication that the Veteran has been prescribed for treatment of his PTSD. If there is any potential interrelation between sleep disability symptoms and medication treatment for PTSD, the examiner should explain in detail. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. 3. After completing the instructions in paragraph one, supra, arrange to have the Veteran scheduled for a VA examination of his PTSD. The examiner should review the record and conduct a complete PTSD evaluation. All indicated tests should be conducted and the results reported. 4. After completing the instructions in paragraph one, supra, arrange to have the Veteran scheduled for a PTSD examination of his colon and any ulcers of the digestive system. The examiner should review the record. If possible, the examiner should be an individual other than the provider(s) who issued the previous VA examinations. The examiner should offer an opinion detailing the existence of gastrointestinal ulcers and/or related symptoms and whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that any such disability had its onset in, or is otherwise attributable to, the Veteran’s 20 years of active duty service. In so doing, the examiner should discuss the Veteran’s reports that his abdominal pain symptoms began in service. Specifically, the examiner should discuss the Veteran’s symptoms that have been noted to begin in 1991 and during combat in the Gulf War. The examiner should also discuss the effects of any medication that the Veteran has been prescribed for treatment of his PTSD. If there is any potential interrelation between gastrointestinal disability symptoms and medication treatment for PTSD, the examiner should explain in detail. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. Furthermore, the examiner should not rely on the absence of in-service treatment records as the basis of an explanation. 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 Veteran’s claim 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. Roya Bahrami Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board F. Lanton, 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.