Citation Nr: 21025963 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 15-34 454 DATE: April 29, 2021 REMANDED A claim for service connection for a sleep disorder, separate and apart from a mood disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2000 to September 2005. In a March 2013 rating decision, the Regional Office (RO) denied service connection for sleep disturbances, separate and distinct from service-connected mood disorder. The Veteran appealed. In June 2020, the Board remand the claim, instructing the RO to obtain a medical opinion as to the nature and etiology of the Veteran’s claimed sleep disturbances that are separate and distinct from his sleep impairment associated with his service-connected mood disorder, specifically noting that such an opinion must be obtained from a physician or a psychiatrist, not a psychologist. In September 2020, contrary to the Board’s directives, the RO obtained an opinion from a psychologist. As a matter of law, the RO must substantially comply with the Board’s remand directives. See Stegall v. West,11 Vet. App. 268 (1998). Of note, in January 2019, the Board remanded the claim on the same grounds because the RO obtained an opinion of a psychologist rather than of a physician, as requested. At that time, the Board noted that a psychologist is not a physician and therefore has found that the RO did not substantially comply with the Board’s remand directives. Accordingly, in June 2020, the Board again remanded the claim, specifically requesting an opinion of a physician or a psychiatrist, that is, a medical professional with MD or DO credentials, while specifically noting that an opinion of a psychologist was insufficient to decide the claim. To be clear, the Veteran is contending that he was diagnosed with a delayed sleep phase syndrome (insomnia) in a November 2015 VA examination and he believes that he suffers from sleep disturbances that are separate from his service-connected mood disorder. He had served during the Gulf War, to include Kuwait, Qatar, Saudi Arabia, and Iraq, and has multiple service-connected disabilities including Chron’s disease, neck and back disabilities, and allergic rhinitis/sinusitis. As such, the Board needs to know whether the Veteran has a stand-alone sleep disorder that is separate and distinct from his psychiatric symptomatology of chronic sleep impairment, and, if so, whether an underlying pathophysiological mechanism is etiologically related to his service, including service in the Southwest Asia during the Persian Gulf War, The Board must also consider whether the Veteran’s sleep disturbances are symptom manifestations of an undiagnosed illness or a medically unexplained chronic multi-symptom illness. Accordingly, the matters are REMANDED for the following action: Obtain a medical opinion as to the nature and etiology of the Veteran’s claimed sleep disturbances. Such an opinion must be obtained from a medical professional with MD or DO credentials (Not a psychologist). Failure to use the appropriate medical professional as the examiner will result in an additional remand. If an in-person examination is deemed necessary to answer the Board’s questions, one should be provided. The examiner is asked to answer the following questions: a) Does the Veteran have a stand-alone sleep disorder that is separate and distinct from his psychiatric symptoms of chronic sleep impairment? Why or why not? b) If a separate diagnosis is rendered, is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep disorder, however diagnosed, began in or was otherwise caused by the Veteran’s active military service? Why or why not? c) If a separate diagnosis is rendered, but less likely as not (less than 50 percent probability) directly related to service, is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep disorder, however diagnosed, was proximately caused by or resulted from any of his existing service-connected disabilities? Why or why not? d) If a separate diagnosis is rendered, but less likely as not (less than 50 percent probability) was caused by any existing service-connected disability, is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep disorder, however diagnosed, was aggravated (made worse) by any of his existing service-connected disabilities? Why or why not? (Continued on the next page)   If aggravation is found, the examiner should provide the baseline manifestations of the Veteran’s sleep disorder prior to aggravation, render an opinion as to the degree of aggravation, and either explain why so or why such an opinion cannot be rendered. e) If a separate diagnosed is not found, is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep disturbances are manifestations of an undiagnosed illness or a medically unexplained chronic multi-symptom illness? Why or why not? MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alex Bardin, 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.