Citation Nr: 21032496 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-14 671 DATE: May 27, 2021 REMANDED The issue of service connection for sleep apnea is remanded. The issue of service connection for hypertensive vascular disease is remanded. The issue of service connection for allergic rhinitis is remanded. REASONS FOR REMAND The Veteran served on active duty served in the Navy from July 1985 to July 1995. These matters come before the Board of Veterans' Appeals (Board) from a November 2013 rating decision. The Veteran testified before the Board at a hearing in March 2021. A transcript of the hearing has been associated with the claims file. Sleep Apnea The Board finds that further development is necessary regarding the Veteran's claim of service connection for sleep apnea. In December 2012, the Veteran submitted a statement in support of a claim contending that his sleep apnea is secondary to his service-connected sarcoidosis. In October 2013, the Veteran was afforded a VA examination regarding his claim of service connection for sleep apnea. Corresponding to the Veteran's contention at the time, the VA examiner provided a negative nexus opinion regarding only whether the Veteran's sleep apnea is caused by his service-connected sarcoidosis and did not address whether the Veteran's sleep apnea may have been incurred in or caused by service. In February 2019, the Veteran submitted letters from two fellow soldiers, which he contends demonstrate that his sleep apnea symptoms began during service. In February 2019, the Veteran also submitted a positive nexus opinion from his private physician stating that the Veteran's sleep apnea is more than likely a direct result of service; however, the Board finds this opinion to be merely conclusory as the physician did not provide a medical rationale regarding the nexus relationship between the Veteran's sleep apnea and service. Therefore, as the February 2019 private opinion is merely conclusory in nature and the October 2013 VA examination opinion did not address direct service connection, the Board finds that the current medical evidence is not sufficient to adjudicate the Veteran's claim. In light of the evidence submitted in February 2019 indicating that the Veteran's sleep apnea may have been incurred in or caused by service, the Veteran should be afforded an addendum VA examination opinion regarding service connection for sleep apnea based on direct service connection. 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Thus, the matter must be remanded to obtain an addendum VA examination opinion. Hypertensive Vascular Disease The Board finds that further development is necessary regarding the Veteran's claim of service connection for hypertensive vascular disease. In the March 2021 hearing before the Board, the Veteran stated that he has received treatment for hypertensive vascular disease since service. Further, the Veteran stated that he has received medical treatment for hypertensive vascular disease from VA, including at the Jacksonville VA Medical Center, since approximately 2002. The Board has reviewed the claims file and finds that the earliest VA medical records associated with the claims file are dated December 2011. Therefore, the Board finds that a remand is required to seek any VA medical records since 2002. 38 C.F.R. § 3.159 (c)(3); Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016). Allergic Rhinitis The Board finds that further development is necessary regarding the Veteran's claim of allergic rhinitis. During the March 2021 hearing before the Board, the Veteran stated that during service he experienced chronic nosebleeds associated with allergy symptoms and received medical treatment on many occasions. Further, the Veteran also stated that following service he sought emergency medical care for nosebleeds associated with allergy symptoms. In October 2013, the Veteran was afforded a VA examination regarding his claim of service connection for allergic rhinitis. The examiner stated that the Veteran's "allergic rhinitis, hay fever, preexisted service and that there is no evidence of aggravation due to service, opinion not indicated." This was apparently in response to the question that had been posed to the examiner; was the Veteran's "post nasal drip at least as likely as not ... incurred in or caused by allergic rhinitis that occurred 8/28/85." The examiner did not further discuss the Veteran's service treatment records (STRs), with the exception of the notation of hay fever during the Veteran's May 1985 entrance examination. The Board has reviewed the Veteran's STRs and finds that these records document multiple occasions of medical treatment for chronic nosebleeds, including nosebleeds associated with allergy symptoms. Therefore, as the examiner did not discuss the Veteran's relevant in-service medical treatment the Board finds the October 2013 VA examination to be inadequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Thus, the matter must be remanded to obtain an addendum VA examination opinion. The matters are REMANDED for the following action: 1. Obtain all treatment records that are not already of record from any VA facility from which the Veteran has received treatment and associate the records with the claims file, specifically including VA treatment records from Jacksonville VA Medical Center from 2002 to the present. If no records exist prior to 2011, that should be indicated. 2. Ask the Veteran to complete a VA Form 21-4142 for any private medical providers that the Veteran may have seen regarding his allergic rhinitis with chronic nosebleeds, including the emergency room visit identified in the March 2021 hearing before the Board. Make two requests for the authorized records from any identified medical providers unless it is clear after the first request that a second request would be futile. 3. Obtain an addendum VA examination opinion regarding the Veteran's allergic rhinitis with chronic nosebleeds. Service connection claim. The claims folder must be made available to and be reviewed by the examiner. The examiner should address the following: a. Does the Veteran have a current diagnosis of allergic rhinitis with chronic nosebleeds. If so, the examiner should address whether the Veteran's allergic rhinitis with chronic nosebleeds clearly and unmistakably preexisted service. The examiner should specifically address the May 1985 entrance examination, including a notation of preexisting hay fever. b. If it is determined that the Veteran's allergic rhinitis with chronic nosebleeds did clearly and unmistakably preexist service, whether it was clearly and unmistakably not aggravated beyond its natural progression by service. The examiner should specifically address the multiple occasions of in-service medical treatment for chronic nosebleeds, including occasions of nosebleeds associated with allergy symptoms. c. If it is determined that the Veteran's allergic rhinitis with chronic nosebleeds did not clearly and unmistakably preexist service, whether it is at least as likely as not (50 percent or greater probability) that the Veteran's allergic rhinitis with chronic nosebleeds was incurred during service, to include the multiple occasions of in-service medical treatment for chronic nosebleeds, including occasions of nosebleeds associated with allergy symptoms. 4. Obtain an addendum VA examination opinion regarding the Veteran's sleep apnea. The claims folder must be made available to and be reviewed by the examiner. The examiner should address the following: a. Is it at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea had its onset during service or is otherwise related to service? The examiner should specifically consider the evidence submitted in February 2019, including a positive nexus opinion from the Veteran's private physician and letters from two fellow soldiers regarding the Veteran's snoring. (Continued on the next page) In providing the requested opinion, the examiner should consider and discuss all pertinent medical and lay evidence of record, to include the Veteran's assertions as to the nature, onset, and continuity of such problems since service. Notably, the absence of documented evidence of a diagnosis or associated symptoms during and shortly after service should not, alone, serve as the sole basis for a negative opinion. 5. Upon completion of any additional action deemed necessary, the agency of original jurisdiction (AOJ) should readjudicate the claims. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Page-Nelson, 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.