Citation Nr: 21025001 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 14-34 943 DATE: April 27, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for a chronic eye disability, to include myopia and retinal detachments, is remanded. The issue of whether new and material evidence has been received to reopen a claim of service connection for a sinus disability is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from May 1980 to December 1984. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2018, the Board remanded the instant issues on appeal for further development. The issues have returned to the Board. 1. Entitlement to service connection for obstructive sleep apnea is remanded. The Veteran seeks entitlement to service connection for obstructive sleep apnea. The Veteran’s service treatment records do not reflect that he had any sleep disorders upon entry into active service, nor do they reflect that he was treated or diagnosed with a sleep disorder during active service. However, the Veteran’s December 1984 report of medical history shows that he indicated some insomnia during the last four months. Post-service medical records show that the Veteran was diagnosed with sleep apnea in 2012. See June 2012 VA treatment record. Throughout the appeal period, the Veteran has stated that he first began experiencing symptoms of this condition in service. The evidence of record includes competent and credible statements from the Veteran, his spouse, his grandmother, and a fellow servicemember. In a May 2012 statement, the Veteran’s spouse indicated that, for several years, she witnessed the Veteran having difficulty sleeping. She stated that his breathing stops when he is sleeping, and at times, it wakes him up at night. Several statements were submitted in September 2013 by the Veteran’s spouse, his grandmother, his roommate in service, and the Veteran. On VA examination in October 2019, the Veteran reported that in service, he was known for snoring and gagging for air when sleeping. The examiner provided a negative nexus opinion. While the October 2019 VA examiner concluded that there was no causal relationship between obstructive sleep apnea and the Veteran’s service-connected psychiatric disorder, the examiner did not provide an opinion as to whether the Veteran’s psychiatric disorder aggravated his sleep apnea. The examiner also did not discuss the many lay statements of record indicating that the Veteran snored during service and shortly thereafter and had trouble sleeping. Therefore, a new VA opinion is necessary. 2. Entitlement to service connection for a chronic eye disability, to include myopia and retinal detachments, is remanded. The Veteran contends he has an eye disability that was incurred in and due to his time in service. In a July 2020 statement, the Veteran raised a new theory of entitlement. He asserted that his claimed chronic eye disability is directly related to his service-connected psychiatric disorder (which is not at issue in this appeal), indicating that his loss of vision is related to the mental trauma, anxiety, and stress that he endured in the military. The Veteran was afforded a VA examination for his claimed chronic eye disability in October 2019. The examiner provided diagnoses of retinal detachment of the right eye, cataract of the right eye, and chorioretinal scar of the left eye. The examiner opined that the Veteran’s diagnosed conditions are less likely as not due to an in-service injury, including conjunctivitis. As rationale, the examiner explained that conjunctivitis does not cause retinal detachment. The examiner indicated that the Veteran has high myopia, which is a risk factor for retinal detachment. A cataract is often a residual of retinal detachment surgery, so it is at least as likely as not due to the Veteran’s retinal detachment surgery. The examiner further stated that conjunctivitis does not cause a chorioretinal scar, and there is no evidence in medical literature that shows such a relationship. The examiner also opined that the Veteran’s myopia was not subjected to any disease or injury during service. The record does not include a medical opinion addressing secondary service connection. Thus, in light of the new theory presented in the Veteran’s July 2020 statement, the Board finds that a remand is required to obtain a VA addendum opinion addressing the possible etiological connection between the service-connected psychiatric disorder and his claimed chronic eye disability. 3. The issue of whether new and material evidence has been received to reopen a claim of service connection for a sinus disability is remanded. In the September 2018 decision/remand, the Board instructed the agency of original jurisdiction (AOJ) to readjudicate the claims on appeal after additional development had been completed. While a supplemental statement of the case (SSOC) was issued in May 2020, the AOJ only addressed the issues of entitlement to service connection for a chronic eye disability and obstructive sleep apnea. The AOJ did not address whether new and material evidence had been submitted to reopen a claim for service connection for a sinus disability. Therefore, to ensure compliance with the September 2018 remand directives, a remand is required of issuance of an SSOC addressing this issue. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the examiner who performed the October 2019 VA examination for sleep apnea. The Veteran’s claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. If the October 2019 examiner is not available, the claims file should be provided to an appropriate medical professional so as to render the requested opinion. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. The examiner should provide an opinion as to whether it is at least as likely as not (within a 50 percent probability or greater) the Veteran’s obstructive sleep apnea was aggravated by his service-connected psychiatric disorder, low back disorder, neck pain, or pes planus, meaning made his sleep apnea worse. The examiner should discuss or acknowledge review of the January 2021 private positive opinion. The examiner should also discuss the many lay statements of record stating that the Veteran was experiencing snoring, interrupted sleep, and daytime sleepiness during service and following service, and provide an opinion as to whether the Veteran’s sleep apnea was at least as likely as not (within a 50 percent probability or greater) etiologically related to his service. 2. Obtain an addendum opinion from the examiner who performed the October 2019 VA eye conditions examination. The Veteran’s claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. If the October 2019 examiner is not available, the claims file should be provided to an appropriate medical professional so as to render the requested opinion. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. The examiner must offer an opinion as to whether it is at least as likely as not that any diagnosed eye disability is secondary to his service-connected psychiatric disorder. The examiner must address all of the Veteran’s statements and reports in relation to the claimed disability. In consideration of all of the Veteran’s statements and reports, the examiner is also asked to offer an opinion as to whether it is at least as likely as not that any currently diagnosed eye disability was either caused or aggravated beyond the natural progression by the Veteran’s service-connected psychiatric disorder. The examiner is informed that aggravation here is defined as any increase in disability. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 3. After completing all indicated development, the Veteran’s claims should be readjudicated based on the entirety of the evidence, to include the claim for service connection for a sinus disability. If any benefit sought on appeal is not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is remanded to the Board. R. Erdheim Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Y. MacDonald, 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.