Citation Nr: 18142641
Decision Date: 10/16/18	Archive Date: 10/16/18

DOCKET NO. 16-12 462
DATE:	October 16, 2018
REMANDED
Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the U.S. Army from October 2000 to March 2001, from May 2002 to April 2005 and from November 2006 to November 2013.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).  
Following the February 2016 statement of the case, the Veteran submitted additional evidence in support of his appeal.  The Veteran filed his substantive appeal in March 2016.  Accordingly, under the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, this evidence is subject to initial review by the Board, because the Veteran did not request in writing that the Agency of Original Jurisdiction initially review such evidence.  See 38 U.S.C. § 7105(e)(1).
1. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected PTSD, is remanded.
In a November 2014 VA opinion, the VA examiner opined that the Veteran’s obstructive sleep apnea was less likely than not incurred in or caused by his chest pain during service.  The VA examiner based that opinion on the findings that the Veteran’s chest pain was associated with his anxiety and that no complaints of sleep disturbance associated with possible sleep apnea were documented during or proximate to his military service.  
Subsequently, in his December 2014 Notice of Disagreement (NOD), the Veteran asserted that his obstructive sleep apnea was caused or aggravated by his service-connected PTSD.  Along with his NOD, the Veteran provided a December 2014 Physician’s Statement by his private treating physician.  Noting that “one cannot say how long this condition existed prior to the date of diagnosis or definitively state its cause,” the private physician opined that it was as likely as not that the Veteran’s service-connected PTSD contributed to or aggravated his sleep apnea.  Given that the December 2014 private opinion is speculative and not based on an underlying rationale, the Board finds that it does not provide sufficient evidence to render a decision. 
Nevertheless, the record shows that in addition to the December 2014 private opinion, the Veteran also submitted two research articles, which suggest a possible link between sleep apnea and psychiatric disorders, including PTSD.  Because the record does not include an adequate opinion with a supporting rationale which addresses whether the Veteran’s obstructive sleep apnea was caused or aggravated by his service-connected PTSD, a remand is required to obtain a supplemental VA opinion.  
The matter is REMANDED for the following actions:
1. Obtain all outstanding treatment records for the Veteran’s obstructive sleep apnea that are not currently of record.
2. Obtain an addendum opinion from an appropriately qualified clinician regarding whether the Veteran’s obstructive sleep apnea is at least as likely as not proximately due to, or aggravated beyond its natural progression by, his service-connected PTSD.  
In providing the above opinion, the examiner should consider the December 2014 private opinion and the two research articles suggesting a link between sleep apnea and psychiatric disorders, including PTSD.
A complete rationale with discussion of medical literature for any opinion expressed must be provided.  If an opinion cannot be expressed without resort to speculation, discuss why this is the case.  
 
LESLEY A. REIN
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Journet Shaw