Citation Nr: 21028111 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-46 300 DATE: May 10, 2021 REMANDED Service connection for a right knee disability is remanded. Service connection for irritable bowel syndrome (IBS) is remanded. Service connection for hypertension is remanded. Service connection for erectile dysfunction (ED) is remanded. Service connection for obstructive sleep apnea (OSA) is remanded. Service connection for a vision loss disability is remanded. A rating in excess of 10 percent for bronchitis is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1990 to August 1994, including service in Southwest Asia during the Persian Gulf War. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision of the Agency of Original Jurisdiction (AOJ). The Veteran participated in a hearing before the undersigned Veterans Law Judge in May 2020, and a transcript of this hearing has been associated with the record. Service Connection for a Right Knee Disability The Board must remand the Veteran's claim for service connection for a right knee disability to obtain an adequate etiological opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran has argued that his right knee disability results from an in-service incident. For example, during his May 2020 hearing before the undersigned, the Veteran alleged that he injured his right knee during boot camp exercises, at which time he "felt something snap but kept on going". The Veteran underwent a VA examination in December 2015, at which time the examiner diagnosed the Veteran with a right knee strain and opined that it was less likely than not that such disability related to his service. The examiner discussed only the Veteran's in-service exposure to environmental hazards while serving in Southwest Asia and did not address the Veteran's claimed boot camp injury. On remand, the AOJ should obtain an additional opinion addressing the etiology of the Veteran's right knee disability, including whether such disability relates to an injury that the Veteran alleges to have occurred during boot camp. Service Connection for Hypertension The Board must remand the Veteran's claim for service connection for hypertension to obtain an adequate etiological opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran claims that he has hypertension either as the direct result of his active service or as the secondary result of his service connected PTSD. In February 2016, an examiner opined that it was less likely than not that such disability related directly to service. The examiner did not, however, address the Veteran's contention that his hypertension is the secondary result of his PTSD. On remand, the AOJ should obtain an additional opinion addressing the etiology of the Veteran's hypertension, including whether such disability has been caused or aggravated by his service connected PTSD. Service Connection for IBS The Board must remand the Veteran's claim for service connection for IBS to obtain an adequate etiological opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran claims that he has IBS either as the direct result of his active service or as the secondary result of his service connected PTSD. In February 2016, an examiner opined that it was less likely than not that such disability related directly to service. The examiner did not, however, address the Veteran's contention that his IBS is the secondary result of his PTSD. On remand, the AOJ should obtain an additional opinion addressing the etiology of the Veteran's IBS, including whether such disability has been caused or aggravated by his service connected PTSD. Service Connection for ED The Board must remand the Veteran's claim for service connection for ED to obtain an adequate etiological opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran primarily claims that he has ED as the secondary result of the medications that he takes in treatment of his PTSD. In February 2016, an examiner opined that it was less likely than not that such disability related to the environmental hazards that he was exposed to during service. The examiner did not, however, address the Veteran's primary contention, namely that he experiences ED as the secondary result of his PTSD. On remand, the AOJ should obtain an additional opinion addressing the etiology of the Veteran's ED, including whether such disability has been caused or aggravated by his service connected PTSD. Service Connection for OSA The Board must remand the Veteran's claim for service connection for OSA in order to provide the Veteran with a medical examination. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran claims that he has OSA either as the direct result of his active duty service or as the secondary result of his service connected disabilities, to include PTSD. The record, including the Veteran's May 2020 testimony before the undersigned and the September 2020 observation of a private clinician, suggests that the Veteran has a diagnosis of OSA. The Veteran has not been afforded a VA examination addressing the nature and etiology of his OSA, and such an examination should be conducted on remand. Service Connection for a Vision Loss Disability The Board must remand the Veteran's claim for service connection for a vision loss disability in order to provide the Veteran with a medical examination. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran claims that he has a vision loss disability as the direct result of his active duty service. The Veteran alleges that his vision was damaged during service as the result of prolonged periods spent staring into radar screens. The evidence shows that the Veteran indeed has experienced a loss of vision, with a June 2002 record noting that the Veteran wears contact lenses. The Veteran has not been afforded a VA examination addressing the nature and etiology of his vision loss disability, and such an examination should be conducted on remand. In so ordering, the Board notes that congenital or developmental defects (such as refractive errors of the eye) are not diseases or injuries for which VA compensation and pension benefits may be granted. See 38 C.F.R. §§ 3.303(c), 4.9. Thus, absent a superimposed disease or injury, service connection may not be granted for refractive error of the eyes, including myopia and presbyopia, even if visual acuity decreased in service. Increased Rating for Bronchitis The Veteran's claim for an increased rating for bronchitis must be remanded in order to provide the Veteran with an additional VA examination to assess whether the Veteran's disability is currently rated under the appropriate Diagnostic Code. The Veteran underwent a VA examination in December 2015, at which time the examiner diagnosed the Veteran with chronic bronchitis. The examiner did not conduct pulmonary function testing to measure the Diffusion Capacity of the Lung for Carbon Monoxide by the Single Breath Method (DLCO (SB)), noting without explanation that such testing was not indicated by the Veteran's condition. The examiner did not address whether the Veteran had any symptoms associated with asthma. In February 2016, the AOJ granted service connection for chronic bronchitis and assigned a 10 percent rating under Diagnostic Code 6600, applicable to chronic bronchitis. See 38 C.F.R. § 4.97. Assigning the proper rating under this Diagnostic Code requires, however, the results of DLCO (SB) testing, which was found to be unwarranted in this case. In September 2020, a private clinician noted that the results of the December 2015 pulmonary function testing were more consistent with a diagnosis of asthma, rather than bronchitis. Thus, the current evidence of record, including the notation of the December 2015 examiner that DLCO (SB) testing was unwarranted, and the September 2020 observation that the Veteran had asthma, rather than bronchitis, is inadequate to properly rate the Veteran's respiratory condition. On remand, the AOJ should afford the Veteran with an additional examination addressing the nature of the Veteran's respiratory disability and conducting all diagnostic testing pertinent to that disability. These matters are REMANDED for the following actions: 1. Obtain an addendum opinion addressing the etiology of the Veteran's right knee disability. If it determined that an additional physical examination of the Veteran is required in order to offer this opinion, such an examination should be scheduled. After reviewing the claims file and considering the Veteran's contentions that he experienced an in-service injury to his right knee, the examiner should opine whether it at least as likely as not (that is, a 50 percent or greater probability) that the Veteran's right knee disability had its onset in service or is otherwise etiologically related to active service. Consideration must be given to his report of injuring his knee during boot camp training. 2. Obtain an addendum opinion addressing the etiology of the Veteran's hypertension. If it determined that an additional physical examination of the Veteran is required in order to offer this opinion, such an examination should be scheduled. After reviewing the claims file and considering the Veteran's contentions, the examiner should opine whether it at least as likely as not (that is, a 50 percent or greater probability) that the Veteran's hypertension: (a.) is caused by his service connected PTSD, or; (b.) underwent any incremental increase in disability, regardless of its permanence, due to the Veteran's service connected PTSD. An "incremental increase in disability" is an additional impairment of earning capacity. Objective measurement or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. 3. Obtain an addendum opinion addressing the etiology of the Veteran's IBS. If it determined that an additional physical examination of the Veteran is required in order to offer this opinion, such an examination should be scheduled. After reviewing the claims file and considering the Veteran's contentions, the examiner should opine whether it at least as likely as not (that is, a 50 percent or greater probability) that the Veteran's IBS: (a.) is caused by his service connected PTSD, or; (b.) underwent any incremental increase in disability, regardless of its permanence, due to the Veteran's service connected PTSD. An "incremental increase in disability" is an additional impairment of earning capacity. Objective measurement or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. 4. Obtain an addendum opinion addressing the etiology of the Veteran's ED. If it determined that an additional physical examination of the Veteran is required in order to offer this opinion, such an examination should be scheduled. After reviewing the claims file and considering the Veteran's contentions, the examiner should opine whether it at least as likely as not (that is, a 50 percent or greater probability) that the Veteran's ED. (a.) is caused by his service connected disabilities, to include the medications that he takes in treatment of such disabilities, or; (b.) underwent any incremental increase in disability, regardless of its permanence, due to the Veteran's service connected disabilities, to include the medications that he takes in treatment of such disabilities. 5. Schedule the Veteran for an examination to address the nature and etiology of his OSA. After reviewing the claims file, conducting any necessary diagnostic testing, and considering the Veteran's contentions, the examiner should address whether it is at least as likely as not (that is, a probability of 50 percent or greater), that the Veteran's OSA: (a.) had its onset in service or is otherwise etiologically related to active service; (b.) is caused by his service connected bronchitis or PTSD, or; (c.) underwent any incremental increase in disability, regardless of its permanence, due to the Veteran's service connected bronchitis or PTSD. An "incremental increase in disability" is an additional impairment of earning capacity. Objective measurement or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. 6. Schedule the Veteran for an examination to address the nature and etiology of his vision loss disability. After reviewing the claims file, conducting any necessary diagnostic testing, and considering the Veteran's contentions, the examiner should: (a.) Diagnose the Veteran's vision loss disability, to include whether any such disability is a refractive error of the eyes, then answer (b.) or (c.) below, as appropriate; (b.) For any vision loss disability that is determined to be a refractive error of the eyes, address whether such disability was subject to a superimposed disease or injury during service, and if so, describe the resultant disability. (c.) For any vision loss disability that is determined not to be a refractive error of the eyes, address whether such disability had its onset in service or is otherwise etiologically related to active service. 7. Schedule the Veteran for an examination to clarify the nature of the Veteran's service connected respiratory disability, to include whether the Veteran's disability is better characterized as chronic bronchitis or asthma. In making this determination, the examiner should address the September 2020 observation that the Veteran's disability was asthma, rather than bronchitis. All pulmonary function testing pertinent to the diagnosed disability should be conducted, including DLCO (SB) testing if the Veteran is diagnosed with chronic bronchitis. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.A. Flynn, 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.