Citation Nr: 18144038
Decision Date: 10/23/18	Archive Date: 10/22/18

DOCKET NO. 17-64 289
DATE:	October 23, 2018
REMANDED
Entitlement to service-connection for obstructive sleep apnea (OSA), to include as secondary to chronic obstructive pulmonary disorder (COPD), is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Marine Corps from January 1986 through August 1998, including service in Southwest Asia.  This matter comes to the Board of Veterans Appeals (Board) on appeal from a December 2016 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).
1. Entitlement to service-connection for OSA, to include as secondary to COPD, is remanded.
The November 2016 medical opinion of record is inadequate, as it does not address whether the Veteran’s obstructive sleep apnea was aggravated by the Veteran’s service-connected COPD.  Additionally, the Board notes that the record raises the issue of direct service connection.  In the November 2016 opinion, the examiner notes that COPD and OSA have very similar symptoms and prevalence.  As the Veteran is service-connected for COPD based upon its symptoms arising in service, it follows that such symptoms could potentially reflect an onset during active duty.  Notably, the Veteran was treated in service repeatedly for bronchitis and upper respiratory infection.  Thus, a direct theory of entitlement should be addressed by the examiner on remand.  Any outstanding treatment records should also be secured.
The matter is REMANDED for the following action:
1. Obtain all outstanding VA treatment records.
2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records.
3. Then obtain an addendum opinion from the November 2016 VA examiner (or other examiner, if unavailable) addressing the etiology of the Veteran’s sleep apnea.  The claims file should be made available to and reviewed by the examiner.  No additional examination of the Veteran is necessary, unless the examiner determines otherwise.
The examiner should opine as to whether it is at least as likely as not (50 percent probability or higher) that the Veteran’s OSA:
(a)	had its onset during active service or is otherwise related to service, to include: (1) his documented in-service treatment of bronchitis and upper respiratory infections and the finding in the November 2016 medical opinion that OSA and COPD, which is service-connected based on these symptoms, have “very similar profiles;” and (2) conceded problems sleeping therein; 
(b)	is proximately due to his service-connected COPD; or 
(c)	has been aggravated (worsened beyond natural progression) by his service-connected COPD.
The examiner should provide a robust rationale for each opinion expressed.  If unable to opine without resorting to speculation, please provide a basis for this conclusion.
 
S. BUSH
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	G.Rouse, Associate Counsel