Citation Nr: 21041348 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 16-45 275 DATE: July 8, 2021 ORDER Service connection for insomnia is granted. REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected insomnia. Entitlement to service connection for depressive disorder, to include as secondary to service-connected insomnia. Entitlement to service connection for alcoholism secondary to service-connected insomnia. FINDING OF FACT The most probative evidence of record demonstrates that the Veteran's insomnia began during his active service and has existed since that time. CONCLUSION OF LAW The criteria for entitlement to service connection for insomnia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1991 to January 1995. This case was previously before the Board in April 2019. In an effort to more adequately reflect the Veteran's contentions as well as the circumstances of this case, the issue of service connection for sleep apnea has been recharacterized as service connection for insomnia and service connection for sleep apnea, to include as secondary to service-connected insomnia. The issue of service connection for "alcoholism/fear of someone behind him" has been recharacterized as service connection for depressive disorder, to include as secondary to service-connected insomnia, and service connection for alcoholism secondary to service-connected insomnia. Laws and regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service- the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a). 1. Entitlement to service connection for insomnia. The Veteran's service treatment records (STRs) reveal that the Veteran complained of having frequent trouble sleeping at the time of his discharge from service. A notation of insomnia, 2 years, was made by the physician assistant (January 1995 Report of Medical History, Box 25). At the September 2018 mental disorders examination, the Veteran indicated that he had experienced sleeping problems since service. The Board finds that the evidence of record supports a finding of service connection for insomnia. First, there is current insomnia disability, as noted on the Veteran's VA problems list (contained in an August 2020 VA mental health note). Although the September 2018 VA examiner stated that the Veteran did not meet the criteria for a diagnosis of insomnia, other records do indicate such a diagnosis. For example, a November 2019 VA neurological record noted that the Veteran's insomnia was improving due to taking Mirtazapine. Further, in June 2019 the Veteran was diagnosed with insomnia disorder by a VA psychologist. Second, the Board finds that there was in-service disease. As noted, the Veteran complained of sleep problems at the time of his separation from service, and a service health care professional characterized the Veteran's sleep problem as being insomnia. Third, the Board finds that the evidence of record supports a finding that the Veteran's insomnia has existed since active service or shortly thereafter. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran has provided competent and credible testimony of sleep problems since service. See Washington, 19 Vet. App. at 368; Caluza v. Brown, 7 Vet. App. 498, 511 (1995). The Veteran is competent to state that he has had sleep problems since service, and the Veteran's contentions in this regard are credible. See Caluza, 7 Vet. App. at 511. The Board thus finds that the Veteran's lay statements are sufficient to establish etiology or continuity of symptomatology. Accordingly, service connection for insomnia is warranted. REASONS FOR REMAND 2. Service connection for sleep apnea, to include as secondary to service-connected insomnia. 3. Service connection for depressive disorder, to include as secondary to service-connected insomnia. 4. Service connection for alcoholism secondary to service-connected insomnia. A June 2018 VA mental disorders examiner noted that the Veteran's primary complaint was poor sleep with nightmares. The examiner then stated that it was "difficult to determine" to what extent [the Veteran's] alcohol use, sleep apnea, and other medical conditions contributed to his poor sleep and depressive symptoms. In light of the grant of service connection for insomnia made in this decision, and in light of the June 2018 VA examiner's comments essentially indicating an interrelationship (albeit undefined) between the disabilities on appeal and the Veteran's insomnia, the Board finds that secondary service connection opinions are necessary to adequately and fairly address the Veteran's contentions in this appeal. The Board observes that the direct service connection opinions obtained in connection with the April 2019 Board remand (concerning sleep apnea and depression) are adequate and do not need to be requested on remand. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment on and after September 11, 2020. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant non-VA medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. 3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to address the medical matters concerning his sleep apnea, depressive disorder, and alcoholism claims. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished. An explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea, depressive disorder, or alcoholism is caused or aggravated by the Veteran's service-connected insomnia. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David Nelson 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.