Citation Nr: 18141322
Decision Date: 10/11/18	Archive Date: 10/10/18

DOCKET NO. 16-30 157
DATE:	October 11, 2018
REMANDED
Entitlement to service connection for sleep apnea is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Army from October 1990 to June 2007, to include in Southwest Asia.  This matter comes before the Board of Veterans’ Appeals (Board) from a July 2013 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA).  
In a December 2017 brief, the Veteran’s representative suggested that the issue of entitlement to an increased evaluation for posttraumatic stress disorder (PTSD) was also on appeal.  However, the Veteran’s VA Form 9 explicitly stated that he was only appealing the issue of service connection for sleep apnea.  Accordingly, the Board does not find that a timely substantive appeal regarding the issue of an increased evaluation for PTSD has been received and that issue is not properly before the Board.
Entitlement to service connection for sleep apnea is remanded.
It appears from the record that there has been some confusion with respect to the theory of entitlement the Veteran asserts supports his claim for service connection for his sleep apnea.  In his October 2012 claim, the Veteran stated that he was claiming sleep apnea as secondary to his hypertension, but he also suggested that sleep apnea was the underlying condition of his already service-connected hypertension.  VA afforded the Veteran a March 2013 medical examination to evaluate his claim.  His diagnosis of obstructive sleep apnea was confirmed, but the examiner ultimately opined that the Veteran’s sleep apnea was unlikely to be the cause of his hypertension.  
Since that time, the Veteran has clarified his contentions.  In a statement received in October 2016, the Veteran explained that the physicians that treated his hypertension during service were not able to control his hypertension despite trying numerous different medications.  He contends that it was only after he was discovered to have sleep apnea and treated for this disability that he was able to control his hypertensive symptoms.  As such, the Veteran appears to be suggesting that the reason that his hypertension was so difficulty to control while on active duty was his untreated and undiagnosed sleep apnea.  In other words, he appears to be stating that the evidence of his uncontrollable hypertension in service represents evidence that his sleep apnea first arose during his active duty service.  As the VA medical opinion from March 2013 did not address this possibility and the Veteran contends that his treating clinicians have confirmed this theory, the Board finds that VA must obtain an addendum opinion.
The matter is REMANDED for the following action:
1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s obstructive sleep apnea is at least as likely as not related to his active duty service.  The examiner should consider and explicitly discuss the Veteran’s suggestion that his obstructive sleep apnea has been preventing his physicians from controlling his hypertension and the evidence of an inability to control his hypertension in service represents evidence that his obstructive sleep apnea first arose during active duty service.
 
DELYVONNE M. WHITEHEAD
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Whitelaw, Associate Counsel