Citation Nr: 22053386 Decision Date: 09/20/22 Archive Date: 09/20/22 DOCKET NO. 17-28 594A DATE: September 20, 2022 ORDER New and material evidence not having been received, the appeal to reopen service connection for a left wrist/forearm nerve disability (claimed as left cubital tunnel and left carpal tunnel syndrome) is denied. Service connection for a left elbow disability other than a left wrist/forearm nerve disability is denied. A rating in excess of 10 percent for hypertension is denied. An effective date prior to November 10, 2014, for a 40 percent rating for right cubital tunnel syndrome is denied. An effective date prior to November 10, 2014, for a 10 percent rating for right cubital tunnel syndrome, limitation of flexion of the right forearm, is denied. REMANDED Entitlement to service connection for a respiratory disorder, to include pulmonary fibrosis, is remanded. Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for a headache disability is remanded. Entitlement to a rating in excess of 40 percent for right cubital tunnel syndrome is remanded. Entitlement to a rating in excess of 10 percent for right cubital tunnel syndrome, impairment of supination and/or pronation, is remanded. Entitlement to a rating in excess of 10 percent for right cubital tunnel syndrome, limitation of flexion, is remanded. Entitlement to a rating in excess of 10 percent for right cubital tunnel syndrome, limitation of extension, is remanded. FINDINGS OF FACT 1. Service connection for left cubital tunnel syndrome (claimed as left carpal tunnel syndrome) was denied in a March 2013 rating decision and the Veteran did not appeal the decision. 2. Evidence received since the March 2013 rating decision is new but not material and does not support the application to reopen service connection for a left wrist/forearm nerve disability. 3. The evidence supports a finding that the Veteran did not have a left elbow diagnosis other than left carpal tunnel syndrome and left cubital tunnel syndrome. 4. For the entire period of appeal, the hypertension required continuous use of medication for control and did not result in diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. 5. Service connection for right cubital tunnel syndrome was granted in a September 1994 rating decision, with a noncompensable rating assigned effective July 1, 1994. The Veteran did not appeal the initial rating assigned. 6. In a March 2013 rating decision, the rating for right cubital tunnel syndrome was increased to 10 percent effective March 11, 2011, and entitlement to a separate rating for limitation of flexion of the right forearm was granted with a noncompensable rating assigned effective March 11, 2011. The Veteran did not appeal the ratings assigned. 7. The Veteran filed an Application for Disability Compensation and Related Compensation Benefits on November 10, 2014, requesting an increased rating for right cubital tunnel syndrome. 8. There is no evidence in the claims file dated between March 2013 and November 2014 that the Veteran filed a claim for an increased rating for right cubital tunnel syndrome, and it is not factually ascertainable that a 40 percent rating for right cubital tunnel syndrome or a 10 percent rating for limitation of flexion of the right forearm was warranted before November 10, 2014. CONCLUSIONS OF LAW 1. New and material evidence has not been received to reopen the claim for service connection for a left wrist/forearm nerve disability. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156, 3.159, 20.1103. 2. The criteria for service connection for a left elbow disability other than a left wrist/forearm nerve disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for a rating in excess of 10 percent for hypertension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.104, Diagnostic Code 7101. 4. The criteria for an effective date earlier than November 10, 2014, for the grant of a 40 percent rating for right cubital tunnel syndrome are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.155, 3.157, 3.159, 3.400. 5. The criteria for an effective date earlier than November 10, 2014, for the grant of a 10 percent rating for right cubital tunnel syndrome, limitation of flexion of the right forearm, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.155, 3.157, 3.159, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from August 1979 to June 1994. The Veteran died in July 2020, and the Appellant is his surviving spouse. The Appellant was substituted in September 2020. The Board remanded the issues in December 2019 for further development, including obtaining outstanding VA treatment records and Social Security Administration (SSA) records. VA treatment records and SSA records were subsequently associated with the record. The Board therefore finds there has been substantial compliance with the remand directives with regard to the issues adjudicated herein. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Stegall v. West, 11 Vet. App. 268 (1998). New and Material Evidence Rating decisions from which an appeal is not perfected become final. 38 U.S.C. § 7105; 38 C.F.R. § § 20.1103. An appeal consists of a timely filed notice of disagreement in writing, and after a statement of the case has been furnished, a timely filed substantive appeal. 38 C.F.R. § § 20.200. To reopen a claim that has been denied by a final decision, new and material evidence must be received. 38 U.S.C. § 5108. New and material evidence means evidence not previously submitted to agency decisionmakers; which relates, either by itself or when considered with previous evidence of record, to an unestablished fact necessary to substantiate the claim; which is neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened; and which raises a reasonable possibility of substantiating the claim. 38 C.F.R. § § 3.156(a). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. Consideration is not limited to whether the newly submitted evidence relates specifically to the reason the claim was last denied, but instead should include whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary's duty to assist or through consideration of an alternative theory of entitlement. Shade v. Shinseki, 24 Vet. App. 110 (2010). For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed, unless it is inherently false or untrue or, if it is in the nature of a statement or other assertion, it is beyond the competence of the person making the assertion. Duran v. Brown, 7 Vet. App. 216, 220 (1994); Justus v. Principi, 3 Vet. App. 510, 513 (1992). 1. New and material evidence to reopen service connection for a left wrist/forearm nerve disability. The Veteran submitted a claim for service connection for left carpal tunnel syndrome in March 2011, which was recharacterized as left cubital tunnel syndrome and denied in a March 2013 rating decision. Relevant evidence included the application for disability compensation benefits, service treatment records (STRs), VA treatment records, and a February 2013 VA examination report. The rating decision noted that STRs did not show any in-service incurrence of left cubital tunnel syndrome. The Veteran did not appeal the March 2013 rating decision and it is final. The Veteran submitted the current request to reopen the claim for service connection for left carpal tunnel in November 2014. Relevant evidence received since the March 2013 rating decision includes the application for disability compensation benefits, VA treatment records, an April 2015 VA examination report, and Social Security Administration (SSA) records. The Board finds that the evidence received since the March 2013 rating decision is new, but it is not material because it does not relate to an unestablished fact necessary to substantiate the claim for service connection for a left wrist/forearm nerve disability. Specifically, the evidence does not show any in-service left wrist or forearm complaints, diagnosis, or treatment, or that any current left wrist/forearm diagnosis was incurred in or due to service. To the extent to which the Veteran and Appellant assert that service connection is warranted for a left wrist/forearm nerve disability, this is cumulative of statements previously made by the Veteran. Reid v. Derwinski, 2 Vet. App. 312 (1992). See also Bostain v. West, 11 Vet. App. 124 (1998) (lay hearing testimony that is cumulative of previous contentions considered by decision maker at time of prior final disallowance of the claim is not new evidence). Thus, the Veteran's and Appellant's lay statements on their own are not sufficient to serve as new and material evidence to reopen the claim. The Board recognizes the threshold for reopening a claim is low, but it is a threshold nonetheless and the evidence that has been added since March 2013 does not reach that threshold. See Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). The evidence submitted since the March 2013 rating decision does not relate to an unestablished fact necessary to substantiate the claim for service connection for a left wrist/forearm nerve disability, and the appeal to reopen service connection is denied. Service Connection To prevail on a direct service connection claim, there must be competent evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or an injury, and (3) a nexus between the in-service disease or injury and the current disability. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). A disability also may be service connected on a secondary basis if it is proximately due to or the result of a service-connected disability or if it is aggravated by a service-connected disability. 38 C.F.R. § 3.310(a) and (b). See also Allen v. Brown, 7 Vet. App. 439 (1995). 2. Service connection for a left elbow disability. The Veteran contended without further elaboration that service connection for a left elbow condition was warranted. See the November 2014 application for disability compensation benefits, December 2015 notice of disagreement. The Board notes as a preliminary matter that Veteran was clearly diagnosed with left carpal tunnel syndrome in December 2006, and had a left carpal tunnel release procedure in February 2015. As discussed above, however, no new and material evidence has been received to reopen the claim for a left wrist/forearm nerve disability. As such, the left elbow issue is limited to a disability other than the carpal tunnel syndrome or cubital tunnel syndrome. STRs contain record of right elbow, hand, and finger complaints and diagnoses in service, but are silent for complaints, diagnosis, or treatment of any left elbow or arm condition. In June 1994, the Veteran opted out of a separation examination. Post-service VA treatment records indicate that June 2011, the Veteran reported having pain in his left hand that radiated to his left elbow. In a February 2013 VA examinations of the right hand and wrist, the Veteran was noted to have pain, paresthesias and/or dysesthesias, and numbness of the left upper extremity, with normal reflexes and sensation, and a reduced range of motion. The examiner indicated that the Veteran had mild incomplete paralysis of the left radial, median, and ulnar nerves, and a diagnosis of cubital tunnel syndrome. In April 2015 VA examinations, the Veteran was again noted to have pain, paresthesias and/or dysesthesias, and numbness of the left upper extremity, with a reduced range of motion, which the examiner noted was "due to suboptimal effort." The examiner indicated that the Veteran had moderate incomplete paralysis of the left median and ulnar nerves, and a diagnosis of cubital tunnel syndrome. In a September 2015 informed consent for long-term opiod therapy, the Veteran was noted to have carpal tunnel in both hands with the location of pain being in the hands, wrists, and elbows. In sum, the Board finds that the weight of the evidence does not establish that the Veteran had any left elbow diagnosis other than carpal tunnel syndrome and cubital tunnel syndrome. The Veteran contended that service connection is warranted for a left elbow disability, but the Board cannot rely on his assertions regarding medical diagnoses. The issue is medically complex and requires specialized medical education and knowledge of the musculoskeletal and neurological systems, as well as knowledge of whether any such diagnosis is separate from well-established carpal/cubital tunnel syndrome. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence, which is silent for mention of any diagnosis of a left elbow disability other than carpal tunnel syndrome and cubital tunnel syndrome. The Board notes that the Veteran was not afforded a VA examination for this claimed disability. Under applicable law, a medical examination and/or opinion is deemed "necessary" if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent lay or medical evidence of a current diagnosed disability or persistent or recurrent symptoms of disability; (2) establishes that the veteran suffered an event, injury, or disease in service, or has a disease or symptoms of a disease listed in 38 C.F.R. §§ 3.309, 3.313, 3.316, and 3.317 manifesting during an applicable presumptive period, provided the claimant has the required service or triggering event to qualify for that presumption; and (3) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability. 38 C.F.R. § 3.159(c)(4). Here, there is no competent and credible evidence event suggesting that any left elbow diagnosis may be associated to the Veteran's military service. As such, an examination is not required. In sum, the Board finds that the Veteran did not have a left elbow diagnosis other than carpal/cubital tunnel syndrome, and did not have a relevant diagnosis at any time during the pendency of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). Increased Rating Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7 3. Increased rating for hypertension. The Veteran's hypertension was assigned a 10 percent rating under Diagnostic Code 7101. Under Diagnostic Code 7101, a 10 percent rating is applicable if diastolic pressure is predominantly 100 or more, or systolic pressure is predominantly 160 or more, or there is a history of diastolic pressure of predominantly 100 or more and continuous medication is required to control blood pressure. A 20 percent rating is warranted if diastolic pressure is predominantly 110 or more or systolic pressure is predominantly 200 or more. A 40 percent rating is warranted where diastolic pressure is predominantly 120 or more. A 60 percent rating is warranted where diastolic pressure is predominantly 130 or more. 38 C.F.R. § 4.104, Diagnostic Code 7101. The Board notes that rating criteria for cardiovascular systems in 38 C.F.R. § 4.104, which includes the ratings for hypertension, were modified effective November 14, 2021. See 86 Fed. Reg. 54089 (Sept. 9, 2021). However, the criteria for hypertension under Diagnostic Code 7101 was not changed, and the Board finds that no other diagnostic codes are pertinent to this claim. In an April 2015 VA hypertension examination, the Veteran's hypertension was noted to be "not well controlled." He had been on medication for almost 30 years, and was currently taking Norvasc, metoprolol, and lisinopril. The Veteran stated that his blood pressure fluctuated daily, and three blood pressure readings were measured as 167/96, 160/96, and 143/87 in the examination. VA treatment records dated during the period of appeal indicate that the Veteran's blood pressure readings varied, including diastolic pressure noted to be between 59 and 86, and systolic pressure noted to be between 102 and 171. He was also consistently noted to be taking at least two medications for blood pressure, including various combinations of lisinopril, metoprolol, furosemide, and amlodipine (Norvasc). In a January 2017 stress echocardiogram report, the Veteran's baseline blood pressure was noted to be 126/73, and at peak stress it was 162/73. Private treatment record dated between September 2017 and February 2020, including a five-day hospital admission in February 2020 for acute on chronic respiratory failure and acute heart failure, indicate blood pressure readings including diastolic pressure between 65 and 84, and systolic pressure between 106 and 129. The Board concludes that for the entire period of appeal, a rating in excess of 10 percent rating for hypertension is not warranted. As noted above, 20 percent rating requires diastolic pressure of predominantly 110 or more or systolic pressure of predominantly 200 or more. Here, the Veteran required continuous medication to treat the hypertension for the entire period of appeal. However, in more than five years' worth of medical treatment records, his diastolic pressure never noted to be above an 86, and systolic pressure was never noted to be above 171. Moreover, an April 2015 VA hypertension examination report and a January 2017 VA stress echocardiogram report are consistent with treatment records and do not show blood pressure recordings of diastolic pressure of predominantly 110 or more or systolic pressure of predominantly 200 or more. As such, a rating in excess of 10 percent for hypertension is not warranted under Diagnostic Code 7101 at any point during the period of appeal. Earlier Effective Date In general, the effective date of an award of disability compensation, in conjunction with a grant of entitlement to service connection, shall be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service; otherwise, the effective date shall be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). The law grants a period of one year from the date of the notice of the result of the initial determination for initiating an appeal by filing a notice of disagreement; otherwise, that determination becomes final and is not subject to the revision on the same factual basis in the absence of clear and unmistakable error (CUE). 38 U.S.C. § 7105; 38 C.F.R. § 3.105(a). An effective date for a claim for increase may be granted prior to the date of claim if it is factually ascertainable that an increase in disability had occurred within one year from the date of claim. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(1) and (2). Thus, according to Harper v. Brown, 10 Vet. App. 125, 126 (1997), three possible effective dates may be assigned depending on the facts of the particular case: (1) if an increase in disability occurs after the claim is filed, the date that the increase is shown to have occurred (date entitlement arose) (38 C.F.R. § 3.400(o)(1)); (2) if an increase in disability precedes the claim by a year or less, the date that the increase is shown to have occurred (i.e., the date the increase is factually ascertainable) (38 C.F.R. § 3.400(o)(2)); or (3) if an increase in disability precedes the claim by more than a year, the date that the claim is received (date of claim) (38 C.F.R. § 3.400(o)(2)). 4. Earlier effective date for the award of a 40 percent rating for right cubital tunnel syndrome. 5. Earlier effective date for the award of a 10 percent rating for right cubital tunnel syndrome, limitation of flexion of the right forearm. Service connection for right cubital tunnel syndrome was granted in a September 1994 rating decision, with a noncompensable (zero percent) rating assigned effective July 1, 1994. The Veteran was notified of the decision in a November 1994 letter, and he did not appeal the issue. As such, the September 1994 rating decision is final. In March 2011, the Veteran submitted a claim for service connection for bilateral carpal tunnel syndrome, which the Regional Office (RO) interpreted as including an increased rating claim for right cubital tunnel syndrome. In a March 2013 rating decision, the rating for right cubital tunnel syndrome was increased to 10 percent under Diagnostic Code 8516, effective March 11, 2011. A separate rating was also granted for limitation of flexion of the right forearm, with a noncompensable rating assigned under Diagnostic Code 5206, effective March 11, 2011. The Veteran's right arm was noted to be his major extremity. The Veteran was notified of the decision in a March 2013 letter, and he did not appeal the issue. As such, the March 2013 rating decision is final. On November 10, 2014, the Veteran submitted a request for an increased rating. In a May 2015 rating decision, the rating for right cubital tunnel syndrome was increased to 40 percent under Diagnostic Code 8513, and the rating for limitation of flexion of the right forearm was increased to 10 percent under Diagnostic Code 5206, both effective November 10, 2014. The Veteran perfected appeals of the effective dates for the increased ratings. The Board finds that an effective date prior to November 10, 2014, for the award of the 40 percent rating for right cubital tunnel syndrome and the award of the 10 percent rating for limitation of flexion of the right forearm is not warranted. First, there is no evidence of any notice of disagreement or request for an increased rating submitted after the March 2013 rating decision and prior to the November 2014 application for increased rating. See 38 C.F.R. §§ 3.151, 3.155; Rudd v. Nicholson, 20 Vet. App. 296 (2006) (holding that a freestanding claim for effective date earlier than the date on which the claim was received, impermissibly attempts to vitiate the rule of finality). In this regard, the Board notes that no written correspondence was received from the Veteran during this period, and telephone communication was related to a claim for nonservice-connected pension and spouse/marriage information. Next, the Board finds that it is not factually ascertainable that a 40 percent rating for right cubital tunnel syndrome was warranted before November 10, 2014. See 38 C.F.R. § 3.400(o). Under Diagnostic Code 8513, for paralysis of all radicular groups, a 20 percent rating is assigned for mild incomplete paralysis of the major or minor extremity, and a 40 percent rating is assigned for moderate incomplete paralysis of the major extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8513. Under Diagnostic 8516, for paralysis of the ulnar nerve, which the right cubital tunnel syndrome was rated under prior to the May 2015 rating decision, a 10 percent rating is assigned for mild incomplete paralysis of the major or minor extremity, a 30 percent rating is assigned for moderate incomplete paralysis of the major extremity, and a 40 percent rating is assigned for severe incomplete paralysis of the major extremity. 38 C.F.R. § 4.124a, Diagnostic Code 8513. A note indicates that combined nerve injures should be rated by reference ot the major involvement, or if sufficient in extent, consider radicular group ratings. Here, in a February 2013 VA peripheral nerves examination, the most recent examination prior to the November 2014 increased rating, the Veteran was noted to have moderate constant pain, mild intermittent pain, moderate paresthesias and/or dysesthesias, and moderate numbness of the right upper extremity. Results of muscle strength, deep tendon reflex, and sensation testing were normal. The examiner concluded that the Veteran had mild incomplete paralysis of the radial nerve, median nerve, and ulnar nerve. The Board also finds that it is not factually ascertainable that a 10 percent rating for limitation of flexion of the right forearm was warranted before November 10, 2014. See 38 C.F.R. § 3.400(o). Under Diagnostic Code 5206, for limitation of flexion of the forearm, a noncompensable rating is assigned where flexion is limited to 110 degrees in the major or minor extremity and a 10 percent rating is assigned where flexion is limited to 100 degrees in the major or minor extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5206. Although portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed. Here, in a February 2013 VA elbow and forearm examination, the most recent examination prior to the November 2014 increased rating, the Veteran's right arm was noted to have 110 degrees of flexion, with objective evidence of painful motion beginning at 110 degrees. After repetitive-use testing with three repetitions, there was no additional limitation of flexion. There was no pain on palpation, and results of muscle strength testing were normal. As discussed above, the Veteran did not appeal the prior March 2013 rating decision that increased the rating for right cubital tunnel syndrome to 10 percent and granted entitlement to a separate noncompensable rating for limitation of flexion of the right forearm. As such, this rating decision is not an appropriate date from which to assign any increased ratings for right cubital tunnel syndrome and flexion of the right forearm, absent a finding that clear and unmistakable error (CUE) has occurred. Accordingly, the benefit of the doubt doctrine is not for application, and the appeals for earlier effective dates for the increased ratings for right cubital tunnel syndrome and flexion of the right forearm are denied. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2022). REASONS FOR REMAND 1. Entitlement to service connection for a respiratory disorder is remanded. In his November 2014 application for disability compensation benefits, the Veteran requested service connection for pulmonary fibrosis. In the May 2015 rating decision, the RO denied service connection on the bases that the evidence failed to show that the Veteran had a diagnosis of pulmonary fibrosis, or that it was incurred in or caused by service. Subsequent VA treatment records dated in January 2016, however, indicate that the Veteran was diagnosed with chronic obstructive pulmonary disease (COPD) and restrictive lung disease. The Board also notes that STRs indicate the Veteran reported potentially relevant symptoms of coughing and chest pain in service, and had a chest x-ray in April 1985. As the Board cannot substitute its medical judgment for that of a qualified medical professional, remand is required to obtain a medical opinion. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). 2. Entitlement to service connection for sleep apnea is remanded. 3. Entitlement to service connection for a headache disability is remanded. In October 2019, the Veteran's former representative submitted a brief indicating that the claims for sleep apnea and headaches were inextricably intertwined with the claim for service connection for an acquired psychiatric disorder that was then pending adjudication. In January 2021, service connection for an acquired psychiatric disorder, to include unspecified anxiety disorder, was granted effective July 14, 2015. VA treatment records indicate that the Veteran was diagnosed with severe obstructive sleep apnea in July 2013. As such, the Board finds that a medical opinion should be obtained to determine the nature and etiology of the sleep apnea. See McLendon v. Nicholson, 20 Vet. App. 79 (2006), 38 U.S.C. § 5103A(d). With regard to the claimed headache disability, the Board notes that the Veteran reported having headaches on several occasions in service between 1984 and 1986, and reported headaches in VA treatment records dated in May 2015, November 2017, and January 2018. In January 2022, a VA medical opinion was obtained on the etiology of the claimed headache disability. The examiner indicated that the evidence did not show a diagnosis of migraine headaches, and as such, the claimed condition was less likely than not proximately due to or aggravated by the service-connected psychiatric disorder. The Board finds that this cursory medical opinion is not a sufficient basis on which to adjudicate the claim for service connection for a headache disability. Specifically, the examiner does not appear to have considered any other type of headache other than migraine headaches, and did not discuss STRs or VA treatment records other than noting that a record in 2006 showed no history of migraines. As such, remand for a medical opinion addendum is necessary. 4. Entitlement to a rating in excess of 40 percent for right cubital tunnel syndrome is remanded. 5. Entitlement to a rating in excess of 10 percent for right cubital tunnel syndrome, impairment of supination and/or pronation, is remanded. 6. Entitlement to a rating in excess of 10 percent for right cubital tunnel syndrome, limitation of flexion, is remanded. 7. Entitlement to a rating in excess of 10 percent for right cubital tunnel syndrome, limitation of extension, is remanded. VA treatment records dated between July 2017 and July 2020 indicate that the Veteran was seen by non-VA medical providers and the corresponding medical documents were scanned into VistA Imaging. Not all of these records have been associated with the claims file, and the Board does not have access to VistA Imaging to determine whether there are any relevant treatment records still outstanding. As such, remand is necessary to associate these records with the claims file. The matters are REMANDED for the following action: 1. Associate with the claims file all non-VA treatment records dated from July 2017 to July 2020, to include associating all treatment records scanned into VistA Imaging and/or located in CPRS. 2. Obtain a VA medical opinion on the nature and likely etiology of any diagnosed respiratory disorder, to include COPD and/or restrictive lung disease. All relevant diagnoses should be noted. For each diagnosis, the examiner should provide a medical opinion on whether it is as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the diagnosis was related to incident, injury, or event in active service. The entire claims file, including a copy of this REMAND, must be reviewed by the examiner. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. 3. Obtain a VA medical opinion on the etiology of the claimed sleep apnea and headache disabilities. All relevant diagnoses should be noted. For each diagnosis, the examiner should provide a medical opinion on: a. whether it is as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the diagnosis was related to incident, injury, or event in active service; and b. whether it is at least as likely as not that the diagnosis was proximately due to any service-connected disability, to include the acquired psychiatric disorder. If not, did any diagnosis increase in severity beyond its natural progression by a service-connected disability? The entire claims file, including a copy of this REMAND, must be reviewed by the examiner. A thorough rationale should be provided for all opinions expressed. If any requested medical opinion cannot be given, the examiner should state the reason(s) why. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. 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.