Citation Nr: 18139525
Decision Date: 10/01/18	Archive Date: 09/28/18

DOCKET NO. 14-24 996
DATE:

REMANDED
Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected chronic fatigue syndrome.
REASONS FOR REMAND
The Veteran served on active duty from January 1991 to October 1991; February 2004 to April 2004; and July 2006 to November 2007 all in the United States Army.
1. Entitlement to service connection for sleep apnea is remanded.
The Veteran has two VA examinations of record regarding his obstructive sleep apnea.  The first, conducted in January 2011, was a VA examination to obtain a medical opinion as to whether the Veteran’s sleep apnea was etiologically related to Gulf War Syndrome.  The examiner did not provide an opinion addressing service connection on a direct basis.  Since that examination the Veteran has submitted two statements from Veterans he served with detailing their first-hand observations of his snoring and breathing difficulties that he contends arose during service.
The second VA examination, conducted in June 2015, provided a medical opinion addressing the theory of service connection for sleep apnea secondary to the Veteran’s service-connected chronic fatigue syndrome.  The examiner opined that the Veteran’s sleep apnea was less likely than not caused or aggravated by his chronic fatigue syndrome, however, the examiner’s rationale only addressed the theory on a causation basis and did not discuss aggravation.  Therefore, an addendum opinion is required to address each outstanding theory of entitlement to service connection.
The matters are REMANDED for the following action:
1.  Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of any obstructive sleep apnea.  The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including whether obstructive sleep apnea had its onset during active duty. 
The clinician must address the statements from fellow service members detailing their observations of the Veteran’s sleeping issues while on active duty. 





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The clinician must also provide an addendum opinion regarding whether the Veteran’s obstructive sleep apnea is at least as likely as not aggravated by service-connected disability.	October 1, 2018
 
EVAN DEICHERT
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	P.S. McLeod