Citation Nr: 18145450 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 16-32 627 DATE: October 29, 2018 REMANDED Entitlement to service connection for obstruction sleep apnea (OSA) is remanded. Entitlement to service connection for mild persistent depressive disorder with anxious distress (hereinafter referred to as a “depressive disorder”) is remanded. Entitlement to a compensable initial rating for other specified trauma- or stressor-related disorder (OSTSRD) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 to July 1990. The record reflects that VA-generated evidence has been added to the claims file since the claim was last adjudicated in a May 2016 Statement of the Case (SOC). Specifically, VA treatment records were added to the claims file in June 2017, subsequent to the May 2016 SOC. A supplemental statement of the case (SSOC) was not issued by the AOJ after considering these VA treatment records. However, the Board finds that readjudication merely based on the addition of these records is not warranted as the VA treatment records are either duplicative of evidence already submitted, or not pertinent as they reflect treatment for or evaluation of other disorders not currently before the Board. Nonetheless, a remand is needed for other reasons, as discussed below. 1. Entitlement to service connection for OSA is remanded. An addendum opinion is necessary in order to address the etiology of the Veteran’s OSA. Specifically, service treatment records (STRs) reflect that during service, the Veteran complained of sinus problems and headaches. In his July 2016 VA Form 9, he also reported daytime sleepiness and headaches while serving aboard the USS South Carolina. However, the April 2016 VA examiner, in finding that the OSA is less likely as not related to service, incorrectly stated that there was no evidence of in-service headaches or daytime tiredness. As such, an addendum opinion is required in order to address these in-service symptoms and to determine whether they are related to the Veteran’s current OSA. Issues 2-3: Entitlement to service connection for a depressive disorder and to a compensable initial rating for OSTSRD is remanded. A new VA examination must be obtained to assess the current severity of the Veteran’s service-connected OSTSRD. The Veteran was last provided a VA examination in June 2015 with an addendum in July 2015. At that time, the Veteran denied any occupational impairment and reported mild social impairment in the form of sometimes preferring to stay home rather than engaging in social activities. Continuous medication was also not required. However, in his July 2016 VA Form 9, the Veteran contended that he now required continuous medication, and had frequent episodes of stress-related and social-related symptoms. Given the indication of a possible worsening of his OSTSRD, a new examination is necessary. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also VAOPGCPREC 11-95 (1995), 60 Fed. Reg. 43186 (1995). Additionally, inasmuch as the OSTSRD claim is being remanded, an addendum, with complete rationale, regarding the etiology of the depressive disorder will also be requested. Also, it is noted that a new VA examination for the Veteran’s OSTSRD may result in new evidence supporting the Veteran’s claim for service connection for a depressive disorder. The matter is REMANDED for the following action: 1. Obtain an addendum from an appropriate examiner to determine the nature and etiology of the Veteran’s claimed OSA. The claims file, and a copy of this remand, will be available to the examiner, who must acknowledge receipt and review of these materials in any report generated as a result. Although a complete review of the record is imperative, attention is called to the following: *A September 1987 STR reflecting the Veteran’s report of sinus problems. *An April 1989 STR reflecting the Veteran’s complaint of headache with vomiting and chills. *July 1990 and April 1991 examination reports reflecting the Veteran’s denial of frequent or severe headaches and frequent trouble sleeping. *A June 2015 VA examination report. *The article submitted by the Veteran in August 2015. *An April 2016 VA opinion. *The July 2016 VA Form 9 in which the Veteran reported daytime sleepiness and headaches during service. AFTER reviewing the claims file in its entirety and examining the Veteran, the examiner is asked to address the following: a) Whether it is at least as likely as not that the Veteran’s OSA was incurred in or related to active duty service. b) Whether the Veteran’s OSA is caused by, aggravated by, or related to any service-connected disability, to include tinnitus, other specified trauma- or stressor-related disorder, and scar on the right eyebrow. A complete rationale should be provided for any opinion provided. 2. Provide the Veteran with a VA examination to determine the current nature and severity of his service-connected OSTSRD and etiology of depressive disorder. All studies, tests, and evaluations deemed necessary should be performed. The examiner is requested to review all pertinent records associated with the claims file. Although a complete review of the record is imperative, attention is called to the following: *VA treatment records from August and October 2014. *A June 2015 VA examination report. *A July 2015 VA addendum. *A July 2015 Report of General Information documenting the RO’s confirmation with the VA examiner regarding his opinion that the Veteran exhibited no symptoms related to his OSTSRD. *The August 2015 Notice of Disagreement in which the Veteran contended that his anxiety while performing some daily tasks was related to his stressor-related disorder. *A September 2015 VA treatment record reflecting the prescription of trazodone to benefit sleep, and assessments of insomnia and caffeine overuse. *The July 2016 VA Form 9 in which the Veteran stated that he now required continuous medication, and had frequent episodes of stress-related and social-related symptoms resulting from his OSTSRD. AFTER reviewing the claims file and examining the Veteran, the examiner is asked to address the following: a) Clarify the nature and severity of the Veteran’s-service connected OSTSRD, specifically any occupational and social impairment resulting from this disability. To the extent possible, identify and describe the symptoms attributable to the service-connected OSTSRD as opposed to any non service-connected psychiatric disorders. If this cannot be done, please state so and explain why. b) Address whether any continuous medication is required specifically for the service-connected OSTSRD. If it is required for insomnia, discuss whether insomnia is a symptom of the Veteran’s OSTSRD. c) Clarify, with rationale, whether a depressive disorder is at least as likely as not (50 percent probability or greater) had an onset during the Veteran’s active service or was caused by or related to service, to include his reported stressor of an incident in June 1989 involving two Libyan Mig fighter jets. All opinions are to be accompanied by a rationale consistent with the evidence of record. 3. Thereafter, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jane R. Lee