Citation Nr: 21041035 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 15-31 755 DATE: July 7, 2021 REMANDED Service connection for varicose veins is remanded. Service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1995 to May 2002. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2012 rating decision. In October 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Travel Board hearing. A transcript of that hearing is of record. The Board notes the issues of entitlement to service connection for a right knee disability, service connection for a left knee disability, service connection for a back disability, service connection for bilateral pes planus, and service connection for hemorrhoids were also remanded by the Board in April 2019. These issues were granted in a March 2021 rating decision and are no longer on appeal. Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of downstream elements such as the disability rating or effective date assigned). 1. Service connection for varicose veins is remanded. 2. Service connection for sleep apnea is remanded. VA opinions for the above claims are of record from October 2020. The examiner provided negative opinions for both conditions. For the Veteran's varicose veins, the examiner states, "there is no objective evidence on exam to support a diagnosis of the claimed condition of varicose veins." The October 2020 examination report notes the Veteran's varicose veins had resolved. For the Veteran's sleep apnea, the examiner states, "Although the [V]eteran has a buddy statement that describes excessive snoring during service there are no other supporting medical records that demonstrate onset of sleep apnea in service." No other rationale was provided. The Board finds both opinions insufficient. Regarding the Veteran's claim for service connection for varicose veins, although the examiner found the Veteran's varicose veins had resolved, the examination report does not reflect whether or not there are any residuals associated with the Veteran's varicose veins especially in light of the medical record showing edema of the left leg. On VA vascular surgery consult in January 2012, mild spider veins were noted. See VA vascular surgery consult, dated January 11, 2012. In May 2019, bilateral lower leg edema was documented and noted not to be a new condition, with the left leg being slightly larger than the right leg. In June 2017, the Veteran reported bleeding from his varicose veins. Marked redness and hardness of the left lower leg was noted. Accordingly, a new examination and opinion are needed that clearly documents whether any residuals associated with the Veteran's varicose veins exist. For the claim for service connection for sleep apnea, the rationale does not reflect a consideration of all the objective and subjective evidence of record. The Board does not find the examiner's opinion adequate for service connection purposes because the examiner did not provide any reasons or bases for not considering the Veteran's buddy statements in reaching their conclusion. Furthermore, at his October 2018 Board hearing, the Veteran recalled being told he snored too loudly during his active service. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Additionally, the examiner did not provide any reasons or bases for not considering the objective evidence of record. They do not address the Veteran's service treatment records showing that he reported frequent trouble sleeping and sometimes waking up with shortness of breath. Finally, as to a current diagnosis, the October 2020 VA Sleep Apnea Disability Benefits Questionnaire notes a date of diagnosis for 2018; however, the Veteran's VA treatment records document a much earlier diagnosis from 2010. Furthermore, a January 2019 Sleep Study documents severe OSA. On the pre-study questionnaire the Veteran reported a history of symptoms that include snoring, having witnessed apnea, gasping awakenings, nightmares, sleepwalking, uncontrollable leg movements described as kicking of the legs, and experiencing trouble falling asleep, trouble staying asleep, daytime somnolence, and uncontrollable sleep attacks. At his October 2018 Board hearing, his testimony reflects a history of similar in-service sleep-related symptoms. Accordingly, an addendum opinion is needed that reflects a consideration of all the evidence of record. Finally, in its prior remand, the Board requested the RO obtain the Veteran's VA treatment records from January 2002 to June 2010 and from January 2019 to the present, from the VA Connecticut Healthcare System, VA Central Western Massachusetts Healthcare System, and VA Boston Healthcare System. However, a review of the record shows the RO obtained most of these records from June 2010 forward; however, there are few records prior to June 2010 and no records prior to 2010 from any facility. As a result, a remand is required to confirm that no additional records are available prior to June 2010 from these facilities. The matters are REMANDED for the following action: 1. Obtain the Veteran's updated VA treatment records from March 2021 forward. 2. Obtain the Veteran's VA treatment records for the period January 2002 to June 2010 from the VA Connecticut Healthcare System, VA Central Western Massachusetts Healthcare System, and VA Boston Healthcare System. If the treatment records are unavailable, a formal finding of unavailability must be issued by the AOJ. If the treatment records are unavailable, the Veteran and his representative must be notified of the unavailability of the VA records, to include the name(s) of the VA facility(ies), the date(s) that are unavailable and the attempts made by the AOJ to locate the records. 3. Schedule the Veteran for a VA vascular examination of his lower extremities. The examiner must review the claims file. (a) The examiner must identify all current vascular disorders of the Veteran's lower extremities, including any varicose veins. In so doing, the examiner should consider the VA vascular surgery consult in January 2012 showing mild spider veins; the June 26, 2017 and June 27, 2017, VA treatment records showing that the Veteran reported that varicose veins on his left leg "broke," with findings of marked redness and hardness of the left lower leg; and the May 1, 2019 treatment note showing bilateral lower leg edema that the Veteran denied being new, with the left leg noted as slightly larger than the right leg. (b) The examiner must opine whether any vascular disorders of the Veteran's lower extremities, including any varicose veins, had their clinical onset during active service or are related to any incident of service, to include as a result of running and from the impact of landing on the ground after jumping from airplanes. In providing the above opinion, the examiner must consider the following: The Veteran has a Parachutist Badge. The service treatment record dated in February 2002 showing complaints of right leg pain and muscle spasm in the leg. The Veteran's VA treatment records (noted above) that document complaints of varicose veins. During the October 2018 hearing, the Veteran stated that he could see varicose veins on his left leg during his active service. All examination findings along with a complete rationale for all opinions expressed must be set forth in the examination report. 4. Obtain an addendum opinion by an appropriate clinician to determine the nature and etiology of the Veteran's sleep apnea. The Board will leave it to the discretion of the examiner to determine whether an in-person examination is necessary. The examiner must opine whether the Veteran's sleep apnea had its clinical onset during active service or is related to any incident of service. In providing the above opinion, the examiner must consider the following: (a.) The Veteran has a current diagnosis of obstructive sleep apnea. (b.) The Veteran's service treatment records show he reported frequent trouble sleeping and sometimes waking up with shortness of breath. (c.) Buddy statements submitted in October 2018 from individuals that served with the Veteran witness the Veteran's loud, excessive snoring that caused him difficulty with breathing during his active service. (d.) On a January 2019 sleep study pre-study questionnaire the Veteran reported a history of symptoms that include snoring, having witnessed apnea, gasping awakenings, nightmares, sleepwalking, uncontrollable leg movements described as kicking of the legs, and experiencing trouble falling asleep, trouble staying asleep, daytime somnolence, and uncontrollable sleep attacks. At his October 2018 Board hearing, his testimony reflects a history of similar in-service sleep-related symptoms. All examination findings along with a complete rationale for all opinions expressed must be set forth in the examination report. P. M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Buck Denton 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.