Citation Nr: 18144927 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 16-36 047 DATE: October 25, 2018 REMANDED The service connection claim for sleep apnea, to include as secondary to service-connected post-traumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Board regrets further delay, but finds that additional development is necessary before a decision may be rendered on the service connection claim for sleep apnea. The Veteran asserts that his sleep apnea is related to his service and/or in the alternative, is secondary to his service-connected PTSD. Among other evidence of an in-service illness of sleep apnea, a January 2016 “Report of Investigation Line of Duty and Misconduct Status” form from service treatment records (STR), expressly indicates that the Veteran developed sleep apnea on Title 10 orders while deployed in support of Operation Iraqi Freedom in 2008, and that the Veteran sought care for this illness 5 years after returning from deployment. A May 2018 Disability Benefit Questionnaire (DBQ) inaccurately reflects that the Veteran was diagnosed with sleep apnea in 2013; and the VA examiner did not provide an etiological opinion on the Veteran’s sleep apnea. When VA undertakes to examine a Veteran, VA is obligated to ensure that that examination is adequate. See Barr v. Nicholson, 21. Vet. App. 303 (2007). Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Thus, given that this VA examination merely provides data, which includes inaccurate data, without an etiological opinion, the Board finds that it is inadequate. Accordingly, a remand is required for a new VA examination and etiological opinion on a direct and secondary basis. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a physician (VA examiner) to assess the nature and etiology of his sleep apnea. The VA examiner must review a complete claims file and must note that review in the report. A copy of this REMAND must also be provided to the VA examiner. All necessary tests and studies should be accomplished and all clinical findings reported in detail. The VA examiner must undertake the following: a. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea is related to his active service. b. Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s sleep apnea is caused by his service-connected PTSD. c. Opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s obstructive sleep apnea has been aggravated by his service-connected PTSD. “Aggravation” means an increase in severity of the disorder beyond any medically established baseline. The appropriate section of the Disability Benefits Questionnaire pertaining to aggravation opinions should be filled out for this purpose, if possible. d. In rendering an opinion, consider all lay statements from the Veteran about onset and symptomatology of his sleep apnea. e. If it is determined that the evidence of in-service treatment and/or diagnosis for sleep apnea is not related to his current disability; or that his sleep apnea is not caused by or aggravated by his service-connected PTSD, please provide a clear, detailed explanation. A detailed explanation is requested for all opinions provided. If an opinion cannot be provided without resort to speculation, provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be rendered. Matthew Tenner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD V-N. Pratt, Associate Counsel