Citation Nr: 18142733 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-44 338 DATE: October 17, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from September 1979 to August 1980. This matter comes before the Board of Veterans’ Appeals (Board or BVA) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Entitlement to service connection for obstructive sleep apnea is remanded. The Board notes that the Veteran asserts that he has obstructive sleep apnea as a result of his service. The medical evidence of record reflects that the Veteran has been diagnosed with and treated for obstructive sleep apnea in the years since his service. Nevertheless, the Veteran has not yet been afforded a VA examination in connection with the claim for service connection of obstructive sleep apnea, which addresses whether the Veteran’s obstructive sleep apnea is causally related to his service, including his service-connected headaches, residuals of a head injury. The Board acknowledges that a May 2016 Disability Benefit Questionnaire (DBQ), completed by a private physician, indicates that the Veteran’s obstructive sleep apnea was related to the Veteran’s service by way of an acquired psychiatric disorder. The Board acknowledges that the Veteran’s claim of entitlement to service connection for an acquired psychiatric disorder is pending, but finds that the May 2016 opinion was insufficient because the private physician did not provide an adequate rationale for his opinion. Additionally, the private physician did not address the Veteran’s assertion that his obstructive sleep apnea was related to his service-connected headaches, residuals of a head injury. Accordingly, the Board finds that the Veteran should be afforded a VA examination regarding the claim for service connection of obstructive sleep apnea. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A(d)(1); 38 C.F.R. § 3.159(c)(4). VA adjudicators may consider only independent medical evidence to support their findings; they may not rely on their own unsubstantiated medical conclusions. If the medical evidence of record is insufficient, VA is always free to supplement the record by seeking an advisory opinion, or ordering a medical examination to support its ultimate conclusions. See Colvin v. Derwinski, 1 Vet. App. 171 (1991). The matter is REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who have treated him for his service-connected disability on appeal. The Veteran should be requested to sign any necessary authorization for release of medical records to VA, and appropriate steps should be made to obtain any identified records. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. If the records are unavailable, notify the Veteran in accordance with 38 C.F.R. § 3.159. 2. The Veteran should be afforded an appropriate VA examination to determine the nature and etiology of obstructive sleep apnea. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file. The VA examiner should render an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s obstructive sleep apnea is related to active service. If the Veteran’s obstructive sleep apnea is not related to his military service, the VA examiner should provide an opinion as to whether his obstructive sleep apnea is proximately due to or the result of the Veteran’s service-connected headaches, residuals of a head injury, or whether his obstructive sleep apnea has been aggravated by any of the Veteran’s service-connected disabilities, including service-connected headaches, residuals of a head injury. The provider is advised that the Veteran is competent to report symptoms, including continuity of symptoms, treatment, and diagnoses and the examiner must take into account, along with the other evidence of record, the Veteran’s statements in formulating the requested opinions. A complete rationale, with specific reference to the relevant evidence of record, should accompany each opinion provided. 3. After completing all indicated development, the RO should readjudicate the claim of entitlement to service connection for obstructive sleep apnea, in light of all the evidence of record. If the benefit sought remains denied, the case should be returned to the Board after compliance with requisite appellate procedures. Gayle Strommen Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Hallie E. Brokowsky, Counsel