Citation Nr: 22017906 Decision Date: 03/26/22 Archive Date: 03/26/22 DOCKET NO. 17-40 714 DATE: March 26, 2022 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected unspecified trauma and stressor disorder/unspecified depressive disorder (hereinafter acquired psychiatric disability,) is remanded. Entitlement to service connection for a headache disability, to include as secondary to service-connected tinnitus and/or claimed obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1984 to December 2004. He testified at a videoconference hearing before the undersigned in August 2021, a transcript is of record. The Board has advanced the Veteran's appeal on the docket, due to indication in the record of homeless status and financial hardship. See a March 11, 2022 Report of General Information. 1. Entitlement to service connection for obstructive sleep apnea, to include as secondary to a service-connected acquired psychiatric disability, is remanded. The Veteran asserts that his obstructive sleep apnea had onset in or is due to his active service, to include exposure to burn pits while serving in Southwest Asia. In the alternative, the Veteran asserts that his service-connected acquired psychiatric disability aggravates his obstructive sleep apnea. See August 2021 Hearing Transcript. The Board cannot make a fully informed decision on the issue of entitlement to service connection for obstructive sleep apnea because no examiner has provided a medical opinion addressing the etiology of the Veteran's sleep apnea. The Veteran has submitted evidence in the form of lay statements, and treatise evidence that triggers VA's duty to obtain such an opinion. On remand, this should be obtained. 2. Entitlement to service connection for a headache disability, to include as secondary to service-connected tinnitus, is remanded. The Veteran asserts that he has a headache disability that had onset in, or is due to his active service, to include exposure to burn pits while serving in Southwest Asia, and/or head injuries obtained while playing in the United States Air Forces Europe Football League (USAFE.) In the alternative, the Veteran asserts that his service-connected tinnitus aggravates his headache disability. See August 2021 Hearing Transcript. The Veteran asserts that his headache disability began following the return from his service in Southwest Asia in 1991. See id. His also contends that his headache disability could be caused by head injuries he received while playing football in service that resulted in possible concussions and/or periods of unconsciousness. Id. The Veteran's service treatment records are silent for diagnosis and treatment for headaches, and during his August 2021 Board hearing, the Veteran testified that he self-treated his headaches for fear that reporting would affect his participation in the Personnel Reliability Program (PRP) or not allow him to continue to play football. The evidence of record is unclear as to whether the Veteran has been diagnosed with a stand-alone headache disability. A December 2014 VA Psychiatric treatment record notes that the Veteran should be referred to the family medicine clinic for assistance with controlling migraine headaches. However, the evidence of record does not include any follow-up or formal diagnosis. A February 2018 private orthopedic evaluation notes that the Veteran has been diagnosed with sleep apnea with headaches. There exists an outstanding medical question as to whether the Veteran has been diagnosed with a stand-alone headache disability or if the Veteran's claimed headaches are simply a manifestation of another disability. As such, the Board cannot make a fully informed decision based on the evidence of record, and remand is warranted. Upon remand, the Veteran should be provided with a VA examination and an etiology opinion obtained. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate examination to determine the nature and etiology of his obstructive sleep apnea. The claims folder must be made available to and reviewed by the examiner. The examiner should take a history from the Veteran as to the progression of his claimed disability. Upon review of the file, interview, and examination of the Veteran, the examiner should provide responses to the following: a) Is it at least as likely as not (approximately 50 percent or greater probability) that the Veteran's obstructive sleep apnea had onset in, or is otherwise related to his active service, to include specifically to exposure to burn pits in Southwest Asia? In responding to the above question, the VA examiner is asked to consider the Veteran's assertion that loud snoring and daytime tiredness during service were indicative of in-service onset of obstructive sleep apnea. If there is medical reason that supports or calls into question the Veteran's report of history, this should be explained. b) Is it at least as likely as not (approximately 50 percent or greater probability) that the Veteran's obstructive sleep apnea is caused or aggravated by his service-connected acquired psychiatric disability? The VA examiner is asked to review and discuss the various medical treatise articles submitted by the Veteran's representative to suggest a possible causal or aggravating relationship between the Veteran's acquired psychiatric disability and his obstructive sleep apnea. The examiner should set forth all examination findings, along with complete rationale for the conclusions reached, in a printed report. Complete rationale should include an explanation of the evidence used in support of the conclusion, as well as an explanation as to why such evidence supports the conclusion. 2., Schedule the Veteran for an examination to determine the nature and etiology of his claimed headache disability. The claims folder must be made available to and reviewed by the examiner. The examiner should take a history from the Veteran as to the progression of his claimed disability. Upon review of the file, interview, and examination of the Veteran, the examiner should provide responses to the following: a) Clarify the Veteran's disability. Specifically, identify whether the Veteran has a stand-alone diagnosis of a headache disorder, or whether headaches are a symptom of another disability, to include sleep apnea. b) Is it at least as likely as not (approximately 50 percent or greater probability) that the Veteran has a headache disability had onset in, or is otherwise related to the Veteran's period of service, to include exposure to burn pits while serving in Southwest Asia and/or the Veteran's head injuries while playing football in the USAFE? In answering the above, the examiner should consider the Veteran's report that he did not seek treatment for head injuries resulting in possible concussion or unconsciousness during service, but rather self-treated injuries for fear of not being allowed to continue playing football. If there is a reason, from a medical perspective, that supports or calls into question the Veteran's reported history of symptoms, this should be made clear. c) Is it at least as likely as not (approximately 50 percent or greater probability) that the Veteran has a headaches disability that was caused or aggravated by the Veteran's service-connected tinnitus, or his obstructive sleep apnea? The examiner should set forth all examination findings, along with complete rationale for the conclusions reached, in a printed report. Complete rationale should include an explanation of the evidence used in support of the conclusion, as well as an explanation as to why such evidence supports the conclusion. 3. Then, readjudicate the issues on appeal. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Bristow Williams, 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.