Citation Nr: 21030199 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 16-07 639 DATE: May 18, 2021 REMANDED Entitlement to service connection for a traumatic brain injury (TBI) is remanded. Entitlement to service connection for an acquired psychiatric disorder is remanded. Entitlement to service connection for a sleep disorder, claimed as sleep apnea is remanded. REASONS FOR REMAND The Veteran had active service from January 1971 to January 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a hearing in January 2020. A transcript is of record. In June 2020, the Board remanded the appeal for additional development. 1. Entitlement to service connection for a traumatic brain injury (TBI) is remanded. 2. Entitlement to service connection for an acquired psychiatric disorder is remanded. 3. Entitlement to service connection for a sleep disorder, claimed as sleep apnea is remanded. The Veteran contends that he suffered a TBI during a vehicle accident in service. At the hearing before the undersigned, the Veteran and his representative asserted that his currently service-connected headaches, and other nonservice-connected memory loss, dizziness, balance problems, and psychiatric symptoms are manifestations of this TBI. The Veteran further asserts that he has an acquired psychiatric disorder and sleep disorder secondary to his service-connected back disability, as a result of chronic pain that interferes with his ability to sleep. His representative asserted at the hearing that chronic pain and depression are interrelated such that leads to depression and depression can worsen the feelings of pain. In June 2020, the Board remanded the appeal so the RO could schedule VA examinations by appropriate clinicians to determine the nature and etiology of any TBI, acquired psychiatric disorder, or sleep disorder. The record shows the Veteran was scheduled for VA-contracted examinations in February 2021 to determine the nature and etiology of his claimed disabilities. Internal correspondence from the VA-contracted facility indicates the Veteran refused to report to these examinations on the basis that he believed VA already had all of the information needed to adjudicate his appeal. In February 2021, the RO sent the Veteran a letter informing him that the examinations were necessary to adjudicate the appeal and requested that he provide a final response regarding his willingness to appear at scheduled examinations. In an April 2021 response, the Veteran wrote that he had appeared at a doctor's office [presumably in connection with the current appeal] but was turned away because he had no appointment. As the VA examinations were cancelled by the RO in February 2021, it appears that he indeed had no scheduled appointment at any medical facility in connection with the current appeal. However, as it appears the Veteran is willing to submit to an examination, the appeal is remanded for another attempt to obtain the necessary nexus opinions. The Veteran is advised that failure to report for any scheduled VA examinations without good cause shown may have adverse effects on his appeal. See 38 C.F.R. § 3.655. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician regarding the nature and etiology of a claimed TBI. The need for an in-person examination is left to the examiner's discretion. The examiner is asked to review the claims file and Remand, and determine whether it is at least as likely as not that the Veteran suffered a TBI during his in-service vehicle accident in April 1971. If so, then the examiner must opine as to whether there are any current residuals related to such TBI and clearly identify all them. A complete rationale must be provided. 2. Obtain an opinion from an appropriate clinician regarding the nature and etiology of any current acquired psychiatric disorder. The need for an in-person examination is left to the examiner's discretion. The examiner is to opine as to whether any current acquired psychiatric disorder is at least as likely as not related to an in-service injury, event, or disease. The examiner should also opine as to whether it is at least as likely as not (a) proximately due to the service-connected lumbar spine or headache disabilities, or (b) aggravated beyond its natural progression by such service-connected disabilities. A rationale must be provided, which reflects consideration of the Veteran's contention that he his service-connected back disability causes severe chronic pain and depression. 3. Obtain an opinion from an appropriate clinician to determine the nature and etiology of any sleep disorder. The need for an in-person examination is left to the examiner's discretion. If the Veteran is found to have a clinically diagnosed sleep disorder, then the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner should also opine as to whether it is at least as likely as not (a) proximately due to a service-connected disability, or (b) aggravated beyond its natural progression by a service-connected disability. A complete rationale must be provided for all opinions. The rationale should reflect consideration of the Veteran's contention that he has a sleep disorder due to his service-connected back disability, as a result of chronic pain that interferes with his ability to sleep. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Lauritzen, 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.