Citation Nr: 21032655 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 18-29 347 DATE: May 27, 2021 REMANDED A rating higher than 10 percent for asthma is remanded. A compensable rating higher for eczema is remanded. A compensable rating for migraine headaches is remanded. A compensable rating for right shoulder tendonitis is remanded. Service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1986 to August 1991, September 1993 to June 1999, September 2002 to August 2003, November 2003 to October 2004 and January 2005 to January 2013. He is recipient of the Bronze Star. In November 2020, the Veteran testified before the undersigned Veterans' Law Judge. A copy of the transcript is associated with the record. Increased ratings for asthma, eczema, migraine headaches and right shoulder tendonitis The Veteran testified in his November 2020 hearing that his conditions had increased in severity. He has not undergone a VA examination in over 5 years. New examinations are warranted. Service Connection for sleep apnea A November 2013 sleep study diagnosed the Veteran with sleep apnea. Upon review of the record, the Board notes that no examination regarding the etiology of the Veteran's diagnosed sleep apnea has been afforded to the Veteran. A July 2013 examination did not diagnose the Veteran with sleep apnea, but also did not perform a sleep study, thus an opinion on the etiology of the Veteran's condition was not provided. The Board affords that examination no probative weight. Remand is necessary for a new examination which addresses the etiology of the Veteran's sleep apnea as the low threshold for obtaining an examination and medical opinion has been surpassed in this case. See 38U.S.C. §5103A (d); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examinations to determine the severity of his service-connected asthma, eczema, migraine headaches and right shoulder tendonitis. The claims file must be made available to the examiner for review in connection with the examination, and it should be confirmed that such records were available for review. All necessary tests and studies should be accomplished, and complaints and clinical manifestations should be reported in detail. The examiner should obtain a detailed clinical history from the Veteran regarding all his claimed conditions. All pertinent pathology (neurological and subjective) found on examination should be noted in the report of the evaluation. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. Including the following: As to the Veteran's asthma, the examiner must administer a complete PFT study and indicate which test result most accurately reflects the level of disability resulting from the service-connected condition. The examiner should also address the type and frequency of medications used to treat the Veteran's asthma, as well as the frequency with which he visits physicians for required care of exacerbations and/or experiences asthma attacks with episodes of respiratory failure. The examiner is asked to specifically address whether the Veteran requires use of systemic (oral or parenteral) corticosteroids or immuno-suppressive medications for the treatment of his asthma; and if so, the frequency and potency (high) of such medications. As to the Veteran's eczema, if the Veteran reports or the records show that the Veteran has continued use of a topical corticosteroid, the examiner must, in addition to answering the other questions on the examination, (1) state whether or not such treatment constitutes systemic therapy because it affects the body as a whole in the treatment of his eczema; and (2) explain the rationale supporting the conclusion. The examiner is to be advised that a topical corticosteroid is a systemic therapy if it affects the body as a whole in the treatment of disease without reference to the area of skin over which it is applied. As to the Veteran's headaches, the examiner should discuss the frequency of the Veteran's attacks, whether they are characteristic prostrating attacks, and the impact on the Veteran's economic adaptability, as appropriate. As to the Veteran's tendonitis, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Schedule the Veteran for an examination by an appropriate physician (M.D.) to determine the nature and etiology of his diagnosed sleep apnea. The claims file should be made available to the examiner for review. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was incurred in, or due to, the Veteran's service. The Veteran's lay statements regarding onset and continuity of symptomology should be recorded and considered. The examiner is specifically asked to consider the Veteran's statements, his November 2020 hearing testimony, and the lay statement of the Veteran's ex-wife regarding the onset and continuation of the Veteran's sleep apnea symptoms. A rationale for all opinions must be provided. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Parrish, 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.