Citation Nr: 18142860 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 16-06 405 DATE: October 17, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1983 to January 1987. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 Rating Decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. 1. Service Connection for Obstructive Sleep Apnea is remanded. The Veteran’s service treatment records show that he complained in service of breathing and sleep difficulties, and he was treated and underwent surgery for a deviated septum in 1985. The Veteran reported that he had fractured his nose as a child and that he had had a deviated septum for “many years.” See service treatment records dated in August 1983 and October 1984. The Veteran’s December 1986 separation Report of Medical Examination noted that the Veteran had no sequalae. Post-service VA treatment records show that the Veteran established care with VA in September 2014 at which time he reported a history of two rhinoplasties in “1995” and 2003. A September 2014 private medical record (Virtua Garden State Pulmonary Associates) noted an assessment of primary hypersomnia with sleep apnea. The Veteran was referred for a sleep study. It was also noted that the Veteran was compliant and benefitting from his CPAP/BiPAP machine. In the May 2015 notice of disagreement, the Veteran claimed that he underwent surgery for a deviated septum in service which did not resolve his symptoms, and that he underwent another operation in 1991 which did not resolve his symptoms. He claimed his symptoms continued until he was diagnosed with sleep apnea. In the February 2016 VA Form 9, the Veteran claimed that he underwent surgery twice in service which did not resolve his symptoms, and that he underwent surgery a third time which also did not resolve his symptoms. He was finally diagnosed with sleep apnea. The Veteran maintained that since using his CPAP he no longer snored and could sleep through the night. For these reasons, the Veteran believes that his breathing and sleep problems in service were wrongly attributed to a deviated septum and were actually due to sleep apnea that went undiagnosed. For service connection claims, VA is obliged to provide an examination and/or obtain a medical opinion where the evidence of record does not contain sufficient competent medical evidence to decide the claim but (1) the record contains competent lay or medical evidence of a diagnosed disability or persistent or recurrent symptoms of disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease manifesting during the pertinent presumptive period, and (3) indicates that the claimed disability or symptoms may be associated with the in-service event, injury, or disease, or with another service-connected disability. See 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence 'indicates' that there 'may' be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). As the record contains evidence of a current disability, establishes that the Veteran experienced an event in service, and indicates that the claimed disability may be associated with the in-service event, the Board will afford the Veteran an examination and opinion to assist him in substantiating his claim. Relevant treatment records should also be procured. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all private health care providers (including Virtua Garden State Pulmonary Associates) who provided treatment for his sleep apnea, including the conduction of any sleep study (and the results thereof) since his discharge from service. Make two requests for the authorized records from the identified private health care providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA treatment records for the period from September 2014 to August 2016 and April 2017 to the Present. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any sleep apnea. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner must consider the Veteran’s contention that his breathing and sleep difficulties in service were wrongly attributed to a deviated septum and were actually due to sleep apnea that went undiagnosed. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. C. Roberson; Law Clerk