Citation Nr: 23039331 Decision Date: 07/17/23 Archive Date: 07/17/23 DOCKET NO. 13-19 457 DATE: July 17, 2023 REMANDED Entitlement to service connection for a sleep disorder, to include as secondary to service-connected disability is remanded. Entitlement to service connection for trench foot is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marines Corps from November 1974 to August 1978. In April 2016, the Veteran testified at a Board hearing before the undersigned. The Veteran provided testimony related to the issue of entitlement to service connection for a sleep disorder. A transcript of the proceeding is associated with the record. In December 2022, the Board remanded the appeal for evidentiary development consistent with the May 2022 and July 2022 United States Court of Appeals for Veterans Claims (the Court) decisions. ? 1. Entitlement to service connection for a sleep disorder, to include as secondary to service-connected disability is remanded. In April 2016, the Veteran testified that his sleep disorder was a symptom of his psychiatric disorder. In August 2019, he was diagnosed with moderate obstructive sleep apnea. In December 2022, the Board remanded the issue of entitlement to service connection for a sleep disorder to obtain an addendum medical opinion that addresses the etiological relationship, if any, between the Veteran's obstructive sleep apnea and service-connected posttraumatic stress disorder (PTSD). VA obtained the requested opinion in January 2023. The VA examiner opined that the Veteran's sleep disorder is less likely than not proximately due to or aggravated by his service-connected PTSD. The rationale for the opinion was that the July 2022 VA examiner did not diagnose the Veteran with insomnia. In the past, the Veteran had sleep issues associated with his bipolar disorder but did not meet the diagnostic criteria for bipolar disorder at the July 2022 VA examination. The Board finds that there has not substantial compliance with the December 2022 Board remand directives. The January 2023 opinion does not address the etiological relationship between the Veteran's moderate obstructive sleep apnea and his service-connected PTSD. A remand is required to obtain an adequate medical opinion that addresses the etiological relationship between the Veteran's PTSD and his moderate obstructive sleep apnea. 2. Entitlement to service connection for trench foot is remanded. In the March 2017 VA Form 9, the Veteran endorsed foot pain since active service. The January 2019 appellate brief asserts that the Veteran's foot disabilities were caused by excess amounts of time spent in the field on training exercises. A January 1975 STR (service treatment record) noted blisters on bilateral hallux. A June 1976 STR noted bilateral heel pain. Another June 1976 STR noted complaint of pain in the left heel, and the impression was pes planus. An October 1977 STR noted complaint of right heel pain, and the impression was soft tissue injury. A February 1978 STR noted complaint of rash on feet, and the clinician noted the Veteran had corns on 2nd and 3rd digits and sent the Veteran to surgical clinic for removal. The clinician also noted soft tissue injury. Another record on the same day noted that the Veteran had history of on-and-off bilateral heel pain that was spontaneously relieved most of the time. In December 2022, the Board remanded the issue of entitlement to service connection for trench foot to obtain an addendum opinion that addresses the etiology of the Veteran's hammer toes, osteoarthritis of the first metatarsophalangeal joint, and hyperkeratotic areas with debridement. VA obtained the requested opinion in February 2023. The VA examiner opined that the Veteran's hammer toes and osteoarthritis of the first metatarsophalangeal joint were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The rationale for the opinion was that there was no evidence of chronicity. The Board finds that the February 2023 opinion is inadequate. The opinion does not address the diagnosis of hyperkeratotic areas with debridement. Furthermore, it is conclusory and not supported by adequate rationale. The VA examiner did not address the Veteran's in-service treatment for foot pain or his contention that his feet have hurt since active service. A remand is required to obtain an adequate medical opinion. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's obstructive sleep apnea is at least as likely as not proximately due to or aggravated by the service-connected PTSD. A rationale must be provided for the opinion. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's hammer toes, osteoarthritis of the first metatarsophalangeal joint, and hyperkeratotic areas with debridement are at least as likely as not related to his active service, to include his in-service treatment for foot pain. Additionally, the VA examiner is asked to address the Veteran's assertion that he has experienced foot pain since service. The Veteran is competent to report foot pain since service. A rationale must be provided for the opinion. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R.R. Watkins, 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.