Citation Nr: 21029767 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 17-53 725 DATE: May 17, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1978 to July 1981 and from November 1990 to May 1991, with additional service in the Reserves. These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision issued by the Department of Veterans Affairs (VA) regional office. The Veteran testified at a hearing with the undersigned in March 2021. 1. Sleep apnea At the hearing, the Veteran testified that he was diagnosed and treated for obstructive sleep apnea at King Khalid Military City (KKMC) and in Hawaii while serving on active duty in the Gulf War between 1990 and 1991. The Veteran specifically noted that he was informed he would stop breathing in his sleep and had someone who was detailed to wake him up. The Veteran noted that he was first diagnosed with the disability at the VA Medical Center in Dallas, TX. As the Veteran has provided competent evidence through testimony of an in-service event, injury or disease, the case must be remanded for a medical opinion. 38 C.F.R. § 3.159 (c)(4). 2. Hypertension The Veteran testified that he was diagnosed with hypertension during a period of active duty for training (ACTDUTRA) during the summer of 1996. As the Veteran has provided competent evidence through testimony of an in-service event, injury or disease during a period of ACTDUTRA training, the case must be remanded for a medical opinion. 38 C.F.R. § 3.159 (c)(4). 3. Diabetes mellitus The Veteran testified that he was diagnosed with diabetes during the same period of ACTDUTRA as the hypertension. The Veteran was afforded an examination in October 2018 that noted the Veteran was diagnosed with diabetes mellitus in 1991. The examination is inadequate as it does not provide an etiology or nexus opinion. Therefore, the matter must be remanded to obtain an adequate opinion as to whether the Veteran's diabetes was related to his Gulf War service or his ACTDUTRA in 1996.38 C.F.R. § 3.159 (c)(4). 4. Bilateral hearing loss The Veteran testified that he has had hearing loss since service as his military position required him to be around artillery and aircraft that caused a lot of noise. The Veteran's military record documents hearing loss. In addition, the Veteran's private treating physician noted the Veteran has hearing loss at higher frequencies and that it most likely is a result of his military service. The Veteran was afforded a VA examination in February 2014 that showed the Veteran experienced hearing loss, but opined that it could not be determined if the hearing loss was from service as there were no records of entry or separation examinations for the Veteran's active duty service to compare and only found hearing test results from 1994 to 1997. This opinion is inadequate as the lack of medical records is not enough to determine whether the Veteran's hearing loss is related to service. A second hearing examination was scheduled where the pure tone test results were considered not valid for VA purposes as they could not be obtained from the Veteran even with repeated instructions. The Veteran volunteered hearing levels that were inconsistent with his Maryland CNC test scores. The examiner did not opine as to the etiology of the hearing loss and therefore the examination is inadequate. 38 C.F.R. § 3.159 (c)(4). The matters are REMANDED for the following action: 1. Contact the Veteran, and, with the Veteran's assistance identify and obtain copies of any pertinent medical or VA treatment records related to his kidney disease, depression, and right shoulder and add them to the claims file. If VA attempts to obtain any outstanding records which are unavailable, the Veteran should be notified. The Veteran specifically identified treatment at the Dallas, TX VAMC. All related records should be obtained. 2. Take all appropriate action to verify the Veteran's periods of Reserve duty and related duty status. Obtain all service treatment records related to that Reserve service. 3. After completion of the above, forward copies of all pertinent records to an appropriate VA examiner to obtain medical opinions on the nature and likely etiology of the Veteran's sleep apnea, hypertension, diabetes mellitus, and bilateral hearing loss. If the examiner determines that an opinion cannot be provided without an examination, (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) one should be scheduled. The AOJ must specify for the examiner the Veteran's periods of service, both active duty and reserve. After reviewing the record, the examiner is asked to answer the following questions, with specific consideration of the duty states identified by the AOJ: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed sleep apnea was incurred in or is otherwise related to service, to include service in the Gulf War? (b) Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed hypertension was incurred in or is otherwise related to service, to include active duty training in the summer of 1996? (c) Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed diabetes mellitus was incurred in or is otherwise related to service, to include active duty training in the summer of 1996? (d) Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed bilateral hearing loss was incurred in or is otherwise related to service? The examiner must provide reasons for each opinion given. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.