Citation Nr: 21031411 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 15-23 914 DATE: May 21, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a left shoulder disability, to include arthritis is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from March 1985 until May 1997. These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) located in Washington, DC. In October 2015, the Veteran testified before the undersigned Veterans Law Judge. In June 2018 and April 2020, the Board remanded the Veteran's claim for additional development. The claim has since been returned to the Board for further appellate action. Unfortunately, the Board finds that remand for further development is again warranted. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for sleep apnea is remanded. In November 2012, the Veteran underwent a sleep study as part of a VA examination. The examiner indicated that the study showed the Veteran to have mild obstructive sleep apnea. As the examiner did not provide a VA etiology opinion, another VA examination was arranged. In June 2019, a different VA examiner examined the Veteran but did not have access to the Veteran's full medical records, including the November 2012 sleep study. Therefore, in July 2020 that examiner was asked to provide an addendum etiology opinion after reviewing the Veteran's full claims file. However, that examiner, looking at the results of the same November 2012 sleep study as the November 2012 VA examiner, stated that a diagnosis of obstructive sleep apnea is not supported. The Board thus finds that a new VA examination, to include a new sleep study, is needed. After all necessary testing is conducted, the VA examiner is asked to opine whether the Veteran has obstructive sleep apnea. If the condition is not diagnosed, the VA examiner should discuss the diagnosis made by the November 2012 VA examiner. If sleep apnea is diagnosed, the VA examiner should opine whether the condition onset in service or is etiologically related to service or the Veteran's service-connected nasal fracture. 2. Entitlement to service connection for a left shoulder disability, to include arthritis is remanded. In its April 2020 remand, the Board ordered that an addendum VA opinion be obtained as to the etiology of the Veteran's left shoulder disability. The Board stated that the examiner should specifically comment on the Veteran's in-service vehicle accident, reports of continuous pain since service, and the November 2012 diagnosis of moderate degenerative osteoarthritis on the left shoulder. The July 2020 addendum opinion obtained does not discuss the Veteran's reports of continuous shoulder pain since service. The Board notes there is also a statement in the record from a fellow servicemember recalling that the Veteran had shoulder pain during service. Another statement made in September 2013 by his wife of, at that time almost 12 years, indicates that the Veteran has complained of shoulder pain as far back as she can remember. The Board further notes that at his November 2012 VA examination the Veteran reported that he often did heavy lifting in service and as he lifted heavy equipment onto tanks he would feel his shoulders ache and pop. The Board also notes that the July 2020 addendum opinion states that the Veteran's diagnosis of arthritis was "apparently made about two decades after leaving service." The Board notes that the diagnosis was made based on X-rays taken in November 2012, 15.5 years after the Veteran's separation from service. The Board finds that the July 2020 addendum opinion is inadequate and a new VA opinion should be obtained. The matters are REMANDED for the following action: 1. Arrange for the Veteran to undergo a new VA examination for obstructive sleep apnea, to include all necessary testing. After all necessary testing is conducted, the VA examiner is asked to opine whether the Veteran has obstructive sleep apnea. If the condition is not diagnosed, the VA examiner should discuss the diagnosis made by the November 2012 VA examiner. If the condition is diagnosed, the examiner should opine as to the following: (a.) Whether it is at least as likely or not that the Veteran's' sleep apnea is etiologically related to his period of active service. The examiner should discuss the statement from a fellow servicemember who recalled the Veteran snoring in service and the statement from the Veteran's spouse indicating that he has snored as long as she can recall. (b.) Whether it is at least as likely as not that the Veteran's sleep apnea is caused or aggravated by the Veteran's service-connected residuals of nasal fracture. If the VA examiner opines that the Veteran's sleep apnea is aggravated, the degree of disability before aggravation and the current degree of disability should be described. A full rationale must be provided for all opinions expressed. 2. Obtain a new VA opinion as to the etiology of the Veteran's left shoulder disability. The examiner should opine as to the following: (a.) Whether it is at least as likely as not that the Veteran's left shoulder arthritis onset in service or within a year of his separation from service. (b.) Whether it is at least as likely as not that the Veteran's left shoulder arthritis is etiologically related to his service, to include his reports of heavy lifting in service and his in-service vehicle accident. (c.) Whether it is at least as likely as not that the Veteran's left shoulder arthritis was caused or aggravated by his service-connected left ulna fracture. If the VA examiner opines that the Veteran's left shoulder arthritis is aggravated, the degree of disability before aggravation and the current degree of disability should be described. The examiner should specifically discuss the Veteran's reports of heavy lifting in service, his in-service vehicle accident, his report of continuous shoulder pain since service, and the September 2013 statements by the Veteran's spouse and a fellow servicemember. A full rationale must be provided for all opinions expressed. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Christensen 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.