17-17 027
17-17 027
| Board of Vet. App. | Aug 13, 2021Background
- Veteran served on active duty in the U.S. Navy from May 2005 to May 2009 and deployed to Southwest Asia (Gulf War era).
- Claims before the Board: left lower‑extremity joint pain (diagnosed as left knee osteoarthritis), a sleep disorder (including sleep apnea; argued as Gulf War undiagnosed illness/MUCMI and as secondary to PTSD and GERD), and headaches.
- Veteran is service‑connected for left knee patellofemoral pain syndrome and left lower‑extremity radiculopathy; prior Board remand (Jan 2019) directed VA exams.
- March and October 2020 VA examinations produced conflicting nexus opinions about whether the diagnosed left knee osteoarthritis is related to the service‑connected patellofemoral syndrome; the Board found the medical evidence in equipoise and granted secondary service connection for left knee osteoarthritis.
- The Board remanded the sleep disorder and headache claims for new, substantially compliant VA examinations because prior examiners failed to address the Veteran’s representative’s April 2017 brief and did not fully follow prior remand instructions; headaches were found inextricably intertwined with the sleep disorder claim.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Service connection for left lower‑extremity osteoarthritis (claimed as joint pain) secondary to service‑connected left knee patellofemoral pain syndrome | OA is a current diagnosis and is proximately due to the service‑connected left knee condition | VA medical opinions conflicted; one negative nexus opinion but acknowledged PFP predisposes to arthritis | Granted on a secondary basis — benefit of the doubt given because evidence was in equipoise; secondary SC established |
| Service connection for sleep disorder (including as undiagnosed illness/MUCMI and as secondary to service‑connected PTSD and GERD) | Sleep apnea/disorder is related to service/Gulf War exposures or is caused/aggravated by PTSD (including medication) and GERD | VA examiners opined sleep apnea has clear anatomical/obesity etiology and is not related to service or aggravated by PTSD/GERD; examiners failed to address representative’s April 2017 brief | Remanded for a new VA exam and etiologic opinions because prior exams did not substantially comply with remand directives and did not address medication/rep brief |
| Service connection for headaches (including MUCMI and as secondary to sleep disorder) | Headaches may be related to sleep apnea and reported onset in bootcamp | Prior examiners did not adequately opine on relation to service or on causal/aggravating role of sleep disorder; record shows possible link to sleep apnea | Remanded — claim is inextricably intertwined with the sleep disorder claim; new exam/opinion required |
Key Cases Cited
- Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004) (articulates the three‑element test for service connection)
- Wallin v. West, 11 Vet. App. 509 (Vet. App. 1998) (elements required for secondary service connection)
- Gilbert v. Derwinski, 1 Vet. App. 49 (Vet. App. 1990) (benefit‑of‑the‑doubt rule when evidence is in equipoise)
- Stegall v. West, 11 Vet. App. 268 (Vet. App. 1998) (requirement that VA comply with remand directives)
- Clemons v. Shinseki, 23 Vet. App. 1 (Vet. App. 2009) (claims for service connection encompass symptoms regardless of diagnostic label)
- Allen v. Brown, 8 Vet. App. 374 (Vet. App. 1995) (principles governing aggravation and secondary service connection)
- Harris v. Derwinski, 1 Vet. App. 180 (Vet. App. 1991) (inextricably intertwined claims doctrine)