Citation Nr: 21032340 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 14-29 096A DATE: May 26, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1982 to November 1993. These matters are before the Board of Veterans' Appeals (Board) on appeal from an August 2013 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2018, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. In March 2019, the Board remanded the Veteran's appeal to the RO for further evidentiary development. 1. Entitlement to service connection for sleep apnea Pursuant to the March 2019 remand, VA opinions were obtained that address whether the Veteran's sleep apnea is related to his service or is caused or aggravated by his service-connected PTSD. However, in July 2019, the Veteran submitted a June 2018 Sleep Apnea Disability Benefits Questionnaire, prepared by private provider S.H., who diagnosed "sleep apnea disorder due to heart disease and PTSD." The provider did not provide a rationale for the statement that sleep apnea was due to heart disease; therefore, this opinion is inadequate for evaluation purposes. However, it raises questions regarding whether the Veteran's sleep apnea is caused or aggravated by his service-connected coronary artery disease, and the record does not contain an adequate medical opinion addressing that question. Therefore, remand is required in order to obtain such a medical opinion. 2. Entitlement to service connection for a right knee disability The Veteran has alleged that his right knee disability is due to a fall down a hatch on a submarine during service. The Veteran is competent to report a fall during service. The Veteran's reports regarding the incident have been relatively consistent and they are consistent with the circumstances of his service aboard a submarine. Therefore, the Board finds his statements about the injury to be both competent and credible. Pursuant to the Board's March 2019 remand, multiple VA opinions were obtained. A VA examination in December 2019 noted the Veteran's reports of his in-service knee injury, but concluded the Veteran's right knee strain was less likely than not incurred during or caused by his service because the Veteran's service treatment records were silent as to any right knee injury in service. In August 2020, an addendum VA medical opinion stated that it was less likely than not that the Veteran's right knee disability was caused by his claimed in-service injury because his service treatment records did not mention the claimed in-service injury. A December 2020 VA examination of the knees found that the Veteran had degenerative arthritis of the right knee. The Veteran reported that in the late 1980s or early 1990s he fell while going down a submarine hatch and injured his knees, back, and neck, and said that he was treated by a corpsman. The Veteran said that he has had knee pain since falling. He also said that he had surgery on the right knee in 2001 but still has a constant burning, stabbing pain in the right knee. The examiner opined it was less likely than not that the right knee condition onset during service or was caused by service because the Veteran's treatment records are silent for a fall during service or any diagnosis of right knee pain, his separation examination in September 1993 was silent for any mention of right knee injury during service, and because medical literature states that knee osteoarthritis is normally the result of wear and tear and progressive loss of articular cartilage due to age as well as wear and tear. The Board finds these VA opinions to be inadequate. Although they note the Veteran's reports of injuring his knee during service, they rely on his service treatment records being silent for treatment for a knee injury. They also do not appear to consider the Veteran's competent statements regarding having knee pain since service. As the Veteran's statements regarding his knee injury and experiencing pain in his knee since that time were not considered in the opinions provided, the opinions are inadequate for evaluation purposes. Therefore, remand for an opinion that considers the Veteran's statements is necessary. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file any updated VA treatment records since April 2021. 2. Ask the Veteran to complete a VA Form 21-4142 for any private providers who have treated him for his right knee disability or sleep apnea, including H.S., Dr. P.Y., Dr. N., or Dr. J.G. Make two requests for any authorized records unless it is clear after the first request that a second request would be futile. 3. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's right knee disability. The claims file should be made available to the examiner for review. If the reviewing clinician determines an examination, including via telehealth, is needed to provide the requested opinion, then such should be scheduled. The reviewing clinician is asked to provide an opinion on the following question: Whether the Veteran's right knee disability is at least as likely as not related to an in-service injury, event, or disease, including a fall down a submarine hatch. In providing an opinion on this question, the clinician should consider the Veteran's statements regarding the in-service fall to be both competent and credible, even though service treatment records do not document treatment for the injury. The clinician should also consider and address the Veteran's testimony regarding experiencing pain in the right knee since the fall and discuss March 2010 and June 2018 opinions from Dr. Y. that indicate that the Veteran's right knee disability is related to the in-service fall. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 4. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's sleep apnea. The claims file should be made available to the examiner for review. If the reviewing clinician determines an examination, including via telehealth, is needed to provide the requested opinion, then such should be scheduled. The reviewing clinician is asked to provide opinions on the following questions: (a.) Is it at least as likely as not that sleep apnea, was caused by the Veteran's service-connected coronary artery disease? (b.) Is it at least as likely as not that sleep apnea was aggravated (that is, any increase in severity beyond the natural progression of the condition) by the Veteran's service-connected coronary artery disease? A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. [SIGNATURE ON NEXT PAGE] M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Dean 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.