Citation Nr: 21023912 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 15-07 453 DATE: April 21, 2021 REMANDED Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. Entitlement to an initial rating in excess of 10 percent for a nightmare disorder (claimed as an anxiety disorder) is remanded. Entitlement to a compensable initial rating for a suprapubic scar is remanded. Entitlement a compensable rating for minimal scar beneath left eyelid with retained foreign body is remanded. REASONS FOR REMAND The Veteran had active service from February 1967 and February 1969. A review of the records shows that there may be outstanding, relevant VA treatment records. VA records from September 2, 2008 and October 7, 2008 note that non-VA internal medicine and primary care records from December 13, 2007 and October 3, 2008 had been scanned into VistA Imaging. VA records from September 9, 2008 and October 18, 2013 that a September 9, 2008 health questionnaire and an October 8, 2013 sleep study report and physician interpretation had been scanned into VistA Imaging. A December 28, 2012 VA entry indicates that non-VA records from Platte Valley Medical from November 19, 2012 were scanned. VA records from October 13, 2017 and May 24, 2018 indicate that a non-VA hospital record from September 15, 2017 and self-charting records from April 3, 2018 were scanned. A May 18, 2018 VA record indicated that an April 23, 2018 non-VA record had been scanned. VA records from November 25, 2019, March 25, 2020, May 19, 2020, October 9, 2020, and January 4, 2021 note that procedure notes and non-VA records from November 28, 2019, January 16, 2020, May 7, 2020, October 5, 2020, and October 29, 2020 had been scanned. It does not appear that these records have been associated with the claims file. A remand to obtain them is required. The record also indicates that there may be outstanding private treatment records. In March 2021, the Veteran submitted a VA 21-4142 authorizing VA to obtain records from Mary Lanning Healthcare urology. These records have not been requested or otherwise obtained. As the Veteran’s suprapubic scar was secondary to his radical prostatectomy, the outstanding records could be relevant to the Veteran’s scar. On remand, reasonable efforts should be made to obtain them. In a March 2021 correspondence, the representative asserted that the Veteran’s sleep apnea was secondary to his service-connected nightmare disorder. The Board cannot make a fully-informed decision on the issue because no VA examiner has addressed this theory of service connection. Accordingly, a remand for a medical opinion is required. The Veteran’s last VA examination assessing his service-connected nightmare disorder was in September 2016. Given the passage of time and the fact that the Board must remand the claim for other development, the Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his nightmare disorder. The Veteran’s last VA examination to assess his service-connected scars was in August 2015. On a February 2016 VA Form 9, the Veteran stated that “both scars itch and are painful at certain times.” As these symptoms were not noted in the VA scar examination report, he should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of his scars. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities. After securing any necessary releases, the AOJ should request any relevant records identified as well as records from Mary Lanning Healthcare. 2. Obtain updated VA treatment records as well as the VistA Imaging records referenced in the September 2, 2008, September 9, 2008, October 7, 2008, December 28, 2012, October 18, 2013, October 13, 2017, May 18, 2018, May 24, 2018, November 25, 2019, March 25, 2020, May 19, 2020, October 9, 2020, and January 4, 2021 VA record entries. Associate all VA treatment records with the claims file. If any requested records are unavailable, the Veteran should be notified of such. 3. After records development is completed, forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran’s sleep apnea. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea was caused by the service-connected nightmare disorder? (b.) If not caused by the service-connected nightmare disorder, is it at least as likely as not that the Veteran's sleep apnea is aggravated by his service-connected nightmare disorder? **The examiner is advised that aggravation need not ben permanent. See Ward v. Wilkie, 31 Vet. App. 233 (2019). (c.) A complete rationale should be provided for all opinions and conclusions expressed. 4. After records development is completed, schedule the Veteran for a VA mental disorders examination to determine the current severity of the Veteran’s nightmare disorder. 5. After records development is completed, schedule the Veteran for a VA scar examination to determine the current severity of the Veteran’s service-connected suprapubic scar and left eyelid scar. **The examiner should address the Veteran’s assertions that the scars itch and are painful and that they have are unsightly and have adhered to the underlying skin. 6. Then, readjudicate the claims on appeal. Romina A. Casadei Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Anderson 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.