Citation Nr: 18142608
Decision Date: 10/17/18	Archive Date: 10/16/18

DOCKET NO. 16-34 695
DATE:	October 17, 2018
REMANDED
Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to a service-connected disability, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1974 to November 1994.  
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2014 rating decision. 
In addition to the claim for sleep apnea, the Board notes that the Veteran filed a notice of disagreement (NOD) with various other issues adjudicated in the April 2014 rating decision.  See May 2014 NOD.  These issues are part of a separate appeal stream and are currently being developed by the Regional Office; as such, the Board will not address these other issues at this time.  
Regarding the Veteran’s OSA, a VA medical opinion was obtained in May 2016.  The examiner opined that the Veteran’s OSA was not proximately due to or the result of the Veteran’s service-connected allergic rhinitis disability.  In support of this opinion, the examiner stated that OSA was mostly likely due to and aggravated by weight gain and obesity.  It was noted that obesity was the major risk factor for OSA.  The examiner cited to a medical article titled “Military Sleep Apnea Cases Skyrocket, Data Show.”
The Board finds the medical opinion inadequate.  In this regard, the examiner did not fully address the medical article referenced in the opinion (previously submitted by the Veteran), which also indicated that factors contributing to sleep apnea also included respiratory issues.  
Further, the Veteran underwent a VA examination in February 2015 for his service-connected GERD disability.  At that time, the examiner noted that the Veteran’s GERD resulted in symptoms of “sleep disturbance caused by esophageal reflux.”  This suggests to the Board that the Veteran’s service-connected GERD may result in some aggravation of the Veteran’s sleep apnea.  Notably, the May 2016 VA medical opinion did not address whether OSA was secondary to the service-connected GERD disability. As such, a new examination is required. 
The matter is REMANDED for the following actions:
1.  Obtain updated VA treatment records.
2.  Then, schedule the Veteran for a VA examination by an appropriate examiner to determine the etiology of the currently diagnosed obstructive sleep apnea.  The examiner must review the Veteran’s claims file.  The examiner should then address the following:
(a.) Opine whether it is at least as likely as not (50 percent or greater probability) that the currently diagnosed sleep apnea is related to service.
(b.) State whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea is either caused or aggravated by the Veteran’s service-connected disabilities, to include allergic rhinitis and/or GERD.   
(c.) The VA examiner is requested to provide a rationale for any opinion provided. 
3. Thereafter, readjudicate the remanded claim on appeal.
 
S. B. MAYS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Casadei, Counsel