Citation Nr: 21041298 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 17-41 347 DATE: July 8, 2021 REMANDED Entitlement to service connection for sleep apnea (claimed as sleep disturbances) is remanded. Entitlement to service connection for a skin condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from January 1988 to March 1988, December 2001 to December 2002, April 2003 to July 2003, and from October 2005 to October 2006. He also served a period of active duty for training (ACDUTRA) from January 1998 to June 1998, with additional service with the West Virginia Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. However, the hearing transcript has numerous inaudible portions. In May 2021, VA sent a letter asking whether he desired to have another hearing. The letter informed the Veteran that if he did not respond within 30 days from the date of the letter, the Board would assume that he did not want another hearing. The Veteran did not respond within 30 days of the May 2021 letter. Therefore, the Board will proceed and consider the evidence of record. Moreover, as the Board is remanding the issues on appeal, should the Veteran wish to have a new hearing, he may request such when the appeal returns to the Board following this remand. See Quinn v. Wilkie, 31 Vet. App. 284 (2019). In March 2020, the Veteran submitted a substantive appeal (VA Form 9) for the issue of entitlement to an increased rating in excess of 30 percent for an unspecified trauma related disorder. The Veteran also requested to appear at a hearing before the Board. As such, the matter will be addressed in a separate decision after the scheduling of a hearing. Service connection claims. The Veteran contends that his sleep apnea and skin condition are related to his active duty to service. For the reasons that follow, the Board finds that additional development is necessary prior to adjudication. The Veteran most recently underwent VA examinations in June 2017 at which time etiology opinions were provided. The examiner diagnosed the Veteran with sleep apnea and rosacea and opined that it was less likely than not that the conditions were related to the environmental exposures the Veteran experienced in Southwest Asia. While the examiner indicated that he considered the Veteran's reports of experiencing symptoms in and since service, he essentially discounted those statements because of an absence of medical records showing sleep problems or a facial rash from separation until 2014. Moreover, with regards to rosacea, the opinion appears to be based on an inaccurate factual premise. While the examiner noted that there was an absence of documentation of a facial rash until 2014, a review of the Veteran's medical records shows a complaint of a papular or nodular skin rash on his face in September 2011. Moreover, in addition to contending that his conditions are related to environmental exposures in Southwest Asia, the Veteran also contends that the conditions are related to exposure to chemicals in service. The evidence of record confirms that the Veteran was exposed to a number of different toxic industrial chemicals in June 2002 when fumes were detected in a hanger the Veteran was working in. See June 2002 memorandums; September 2002 Environmental Exposure Memo for Service Member's Permanent Medical Record; Undated summary of air and soil sample results. However, the examiner did not address whether the Veteran's conditions were related to this chemical exposure. Furthermore, the Veteran has indicated that he also is claiming that his skin condition is a Gulf War illness pursuant to 38 C.F.R. § 3.317. See July 2016 Decision Review Officer (DRO) hearing transcript. Pursuant to 38 C.F.R. § 3.317, a Gulf War illness (qualifying chronic disability) is either an undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI). A condition is considered a MUCMI where either the etiology or the pathophysiology of the illness is inconclusive. If both the etiology and pathophysiology are partially understood, then the condition is not a MUCMI. See Stewart v. Wilkie, 30 Vet. App. 383 (2018). While the examiner opined that the Veteran's skin condition is a diagnosed condition with a clear and specific etiology, he did not address whether the pathophysiology is at least partially understood. See also January 2015 Gulf War General Medical Examination (addressing only whether the etiology is known). In light of the foregoing, the Board finds that a remand is warranted in order to obtain new etiology opinions. The matters are REMANDED for the following action: 1. Obtain a VA medical opinion regarding the etiology of the Veteran's sleep apnea and skin disorder, rosacea, from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand. The examiner must opine: a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's sleep apnea had its onset in, or is otherwise related to active service, to include (1) environmental exposures in Southwest Asia to include dust storms and airborne particulate matter, or (2) the confirmed chemical exposure to toxic industrial chemicals. b) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's skin disorder, rosacea, had its onset in, or is otherwise related to active service, to include (1) environmental exposures in Southwest Asia to include dust storms and airborne particulate matter, or (2) the confirmed chemical exposure to toxic industrial chemicals. In providing the above opinions, the examiner must consider the Veteran's reports of experiencing sleep and skin issues in and since service. The examiner is advised he/she may not merely dismiss the Veteran's statements due to a lack of contemporaneous medical records. c) Is it at least as likely as not that the Veteran's rosacea or sleep apnea is a medically unexplained multi-symptom illness under 38 C.F.R. § 3.317? The examiner is advised that under VA regulations a condition is a MUCMI where either the etiology or pathophysiology of the illness is inconclusive. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran's lay statements. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Mortimer, 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.