Citation Nr: 18143436 Decision Date: 10/23/18 Archive Date: 10/19/18 DOCKET NO. 15-45 035 DATE: October 23, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea, including as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran had active duty service from September 1967 to September 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which denied service connection for sleep apnea. The Veteran and his wife testified before the undersigned Veterans Law Judge (VLJ) in November 2016. A copy of the transcript has been reviewed and associated with the claims file. Entitlement to service connection for obstructive sleep apnea, including as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. The Veteran has been diagnosed with obstructive sleep apnea and asserts that it was incurred in service or, in the alternative, is secondary to his service-connected PTSD. The Veteran and his wife testified at the hearing in November 2016 and indicated that the Veteran had sleeping problems in service, including snoring and fatigue, which continued post-service. Given that the Veteran has a present disability that may be related to service and/or secondary to a service-connected disability, the Board finds that he should be afforded a VA examination to determine the etiology of his obstructive sleep apnea. See McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran’s updated VA treatment records from August 2018 to the present. 2. After completion of #1, schedule the Veteran for a VA examination to determine the etiology of his obstructive sleep apnea. The claims folder, including a copy of this remand, must be made available to the examiner and such review should be noted in the examination report. The examiner should respond to the following: A. Is it at least as likely as not (probability of at least 50 percent) that the Veteran’s obstructive sleep apnea was caused by his service-connected PTSD? B. Is it at least as likely as not (probability of at least 50 percent) that the Veteran’s obstructive sleep apnea has been aggravated (worsened beyond its natural progression) as a result of his service-connected PTSD? If aggravation is found, is there medical evidence created prior to the aggravation or between the aggravation and obstructive sleep apnea that shows a baseline of his obstructive sleep apnea prior to aggravation? If so, please identify. C. If the Veteran’s obstructive sleep apnea was not caused and/or aggravated by his service-connected PTSD, then is it at least as likely as not (probability of at least 50 percent) that his obstructive sleep apnea had its onset in and/or is otherwise etiologically related to his period of active service? The examiner must provide a comprehensive rationale for each opinion provided. Specifically, the examiner must discuss the hearing testimony and statements by his wife and daughter, which indicated that the Veteran had sleeping problems in service, including snoring and fatigue. (Continued on the next page)   The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Hurley, Associate Counsel