Citation Nr: 18144133 Decision Date: 10/24/18 Archive Date: 10/23/18 DOCKET NO. 16-25 642 DATE: October 24, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran had active naval service from November 1979 to March 1990, and active military service from December 2004 to September 2006 and March 2009 to March 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2013 rating decision issued by the VA Regional Office (RO) in Columbia, South Carolina. Service Connection – Obstructive Sleep Apnea The Board finds that additional development is required before the Veteran’s claim on appeal is decided. The Veteran has contended that his sleep apnea is related to his active service in the Gulf War. The Veteran asserted that he was treated twice in July 2009 for problems sleeping during service, and not in July 2008. He noted that he exhibited most of the symptoms for sleep apnea while he was on active duty. However, he stated that he was misdiagnosed and prescribed sleep medication to relieve his symptoms. Service treatment records (STRs) documented that the Veteran was experiencing problems sleeping in July 2009 and had a history of insomnia. Additionally, in a March 2010 post-deployment health assessment, the Veteran indicated that he was still bothered by problems sleeping or still felt tired after sleeping. A review of post-service treatment records showed that the Veteran complained of sleep disturbances and problems sleeping. A January 2009 VA treatment note reflected that the Veteran had a history of snoring. The Veteran was diagnosed with obstructive sleep apnea syndrome in September 2012. The Veteran was afforded a VA examination in September 2012. The examiner opined that it was less likely as not that the Veteran’s sleep apnea was related to a specific exposure event experienced by the Veteran during his service in Southwest Asia. She stated that the Veteran’s sleep apnea had a clear and specific etiology and that there were many risk factors, to include excess weight, neck circumference, a narrowed airway, or family history. In April 2016, a VA examiner opined that the Veteran’s sleep apnea was less likely than not incurred in or caused by his active service. The examiner stated that the Veteran’s STRs did not document a chronic on-going treatment or condition for sleep apnea. He commented that the Veteran was seen briefly for insomnia in July 2009, which was a distinct and separate diagnosis. He noted that the Veteran was not diagnosed with sleep apnea until after his active duty service. The Board finds that the VA examiners did not address the Veteran’s post-deployment complaint of on-going sleep problems and tiredness in March 2010. Additionally, the examiner did not comment on the Veteran’s history of snoring noted in January 2009 as well as the Veteran’s assertion that he had been misdiagnosed. For this reason, the VA examinations are inadequate, and remand is necessary to determine the nature and etiology of any currently present obstructive sleep apnea. Additionally, current treatment records should be identified and obtained before a decision is made in this case. The matter is REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any currently present sleep apnea. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present obstructive sleep apnea is etiologically related to the Veteran’s active service. The examiner should presume that the Veteran is a reliable historian with regard to his report of sleep problems since active service and consider all submitted lay statements, to include his assertion that he was treated for sleep problems on July 2nd and 8th in 2009 and that he was misdiagnosed. The rationale for all opinions expressed must be provided. 3. Confirm that the VA examination report and all medical opinions provided comport with this remand and undertake any other development determined to be warranted. 4. Then, readjudicate the remaining claim on appeal. If the decision remains adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ware, Associate Counsel