Citation Nr: 21015892 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 19-21 373 DATE: March 18, 2021 REMANDED Entitlement to service connection for Raynaud’s syndrome of both hands is remanded. Entitlement to service connection for a respiratory disorder, to include chronic obstructive pulmonary disease (COPD) and bronchial asthma is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a disability of the right gastrocnemius muscle, to include residuals of a muscle tear or chronic strain is remanded. REASONS FOR REMAND The Veteran had active service from April 1987 to April 1991. His military occupational specialty was motor transportation operator. His service included service in Southwest Asia during the Persian Gulf War and service at Camp Lejeune. These matters came to the Board of Veterans’ Appeals (Board) from a March 2017 rating decision of a Regional Office (RO) for Department of Veterans Affairs (VA). The Board denied service connection for the claims listed above in an October 2019 Board decision. Thereafter, the Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In October 2020, the Court granted the Parties’ Joint Motion for Partial Remand (JMPR); and vacated that portion of the October 2019 Board decision which denied service connection for the above issues and remanded these matters for further action consistent with the parties JMPR. The Parties’ October 2019 Joint Motion for Partial Remand agreed that the March 2017 VA examination reports and opinions were not adequate to make a decision on the issues as they did not consider the Veteran’s reports of the onset of these conditions and were largely based on the absence of indications in the Veteran’s service treatment records (STRs) for the conditions on appeal. The Veteran’s STRs are largely illegible or missing and in instances where there are missing or otherwise unavailable service treatment records, VA has a heightened duty to assist the Veteran in developing his claim. See Washington v. Nicholson, 19 Vet. App. 362, 371 (2005), O’Hare v. Derwinski, 1 Vet. App. 365 (1991). The Board notes that the Veteran provided medical opinions regarding the conditions on appeal from a chiropractor, however, these opinions are not adequate and do not provide thorough and well-reasoned opinions regarding the nature and etiology of the Veteran’s conditions. In addition, the Veteran’s chiropractor does not appear to have the medical training or education to provide a medical opinion regarding the nature and etiology of the conditions for which the Veteran seeks service connection, and adequate rationale for each opinion given is not included. As such a remand is necessary. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Ask the Veteran to complete a release for any private healthcare records. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 3. Schedule the Veteran for the appropriate VA examination to determine the nature and etiology of his sleep apnea. The examiner should review the claims file, take a detailed history of the onset of symptoms in service and afterward from the Veteran, and provide the following opinions: Whether it is at least as likely as not that the Veteran’s sleep apnea had its onset in service or is otherwise etiologically related to service, to include his exposure to environmental exposures in Southwest Asia/Gulf War and contaminated water at Camp Lejeune. The examiner should address the Veteran’s contentions that he experienced snoring issues since service. The Veteran is competent to report the nature, onset, and continuity of his symptoms. The examiner should also opine as to whether it is at least as likely as not that the Veteran’s sleep apnea, if not attributable to a known clinical diagnosis, could be considered manifestations of either an undiagnosed illness or a medically unexplained chronic multi-symptom illness? 4. Schedule the Veteran for a VA examination to determine the nature and etiology of any respiratory disorder. The examiner should review the claims file, take a detailed history of the onset of symptoms in service and afterward from the Veteran, and identify all respiratory conditions during the period on appeal and provide the following opinions: Whether it is at least as likely as not that the Veteran’s respiratory condition had its onset in service or is otherwise etiologically related to service? The examiner should accept the Veteran’s reports of being exposed to burn pits during service. The examiner should also consider whether any respiratory condition is related to contaminated water at Camp Lejeune and should consider the Veteran’s reports of the onset and continuity of symptoms from service. The examiner should also opine as to whether it is at least as likely as not that the Veteran’s respiratory condition, if not attributable to a known clinical diagnosis, could be considered manifestations of either an undiagnosed illness or a medically unexplained chronic multi-symptom illness. 5. Schedule the Veteran for a VA examination to determine the nature and etiology of his Raynaud’s syndrome. The examiner should review the claims file, take a detailed history of the onset of symptoms in service and afterward from the Veteran, and provide the following opinions: Whether it is at least as likely as not that the Veteran’s Raynaud’s syndrome had its onset in service or is otherwise etiologically related to service, to include his exposure to environmental exposures in Southwest Asia/Gulf War and contaminated water at Camp Lejeune. The examiner should address the Veteran’s contentions that he experienced cold temperatures during his service in the Gulf War and that this condition began during his service. The Veteran is competent to report the nature, onset, and continuity of his symptoms. The examiner should also opine as to whether it is at least as likely as not that the Veteran’s Raynaud’s syndrome if not attributable to a known clinical diagnosis, could be considered manifestations of either an undiagnosed illness or a medically unexplained chronic multi-symptom illness? 6. Schedule the Veteran for a VA examination to determine the nature and etiology of his right gastrocnemius muscle strain. The examiner should review the claims file, take a detailed history of the onset of symptoms in service and afterward from the Veteran, and provide the following opinions: Whether it is at least as likely as not that the Veteran’s right gastrocnemius muscle strain had its onset in service or is otherwise etiologically related to service. The examiner should address the Veteran’s contentions that regarding the onset of this condition and a full history should be taken. The Veteran is competent to report the nature, onset, and continuity of his symptoms. The examiner should also opine as to whether it is at least as likely as not that the Veteran’s right gastrocnemius muscle strain if not attributable to a known clinical diagnosis, could be considered manifestations of either an undiagnosed illness or a medically unexplained chronic multi-symptom illness? MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board John M. Middleton 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.