Citation Nr: 18146015 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-57 798 DATE: October 30, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to an initial disability rating in excess of 50 percent for unspecified trauma and stressor related disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1983 to November 1987. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) assigning a 50 percent disability rating for unspecified trauma and stressor related disorder and denying service connection for sleep apnea. 1. Entitlement to service connection for sleep apnea is remanded. The Veteran contends that his sleep apnea is aggravated by his service-connected unspecified trauma and stressor related disorder. The Board finds that the April 2017 VA examination addressing the etiology of the Veteran’s sleep apnea is incomplete. Secondary service connection is a two-part issue that involves an analysis of both causation and aggravation. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310 (2017). The April 2017 VA examination did not address whether the Veteran’s service-connected unspecified trauma and stressor related disorder permanently aggravated his sleep apnea. The Board notes that the Veteran submitted a private medical opinion indicating that “it is as likely as not that [his] service connected PTSD contributes to or aggravates his sleep apnea…” While this opinion is favorable to the Veteran, it is not supported by adequate rationale and is based on the inaccurate factual premise that the Veteran is service connected for post-traumatic stress disorder. As such, a supplemental VA opinion is required that addresses aggravation. 2. Entitlement to an initial disability rating in excess of 50 percent for unspecified trauma and stressor related disorder is remanded. The most recent VA examination addressing the current severity of the Veteran’s unspecified trauma and stressor related disorder was completed in August 2016. However, the VA examiner found that the Veteran did not have a current diagnosis of a mental disorder and found that there was a discrepancy between the Veteran’s report of symptoms and the known course of mental health disorders. In February and June 2017 private treatment records, the Veteran’s treating psychiatrist indicated that the Veteran was experiencing a number of symptoms, including sleep impairment, occasional nightmares, panic attacks, and night sweats. As such, the Board requires clarification as to the symptomatology of the Veteran’s service-connected unspecified trauma and stressor related disorder. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records. 2. Thereafter, schedule a VA examination to determine the current nature and severity of the Veteran’s unspecified trauma and stressor related disorder. Provide the claims file, including a copy of this REMAND, to the examiner for review. The examiner should review and address prior VA examinations and private treatment records In evaluating the severity of the unspecified trauma and stressor related disorder, the examiner should clarify whether the Veteran has another mental health disorder and, if so, whether it is possible to differentiate what symptoms are attributable to each diagnosis. 3. Obtain a supplemental VA opinion from the April 2017 VA examiner, or, if not available, another appropriately qualified examiner regarding the etiology of the Veteran’s sleep apnea. Only if deemed necessary to provide an opinion, should the Veteran be afforded a new VA examination for his sleep apnea. Provide the claims file, including a copy of this REMAND, to the examiner for review. After reviewing the claims file, the examiner should respond to the following: a. Is it at least as likely as not (50 percent probability or more) that the Veteran’s sleep apnea was proximately due to, or the result of, his service-connected unspecified trauma and stressor related disorder? b. Or, is it at least as likely as not (50 percent probability or more) that Veteran’s sleep apnea was aggravated (increased beyond the natural progression of the disability) by his service-connected unspecified trauma and stressor related disorder? A complete rationale for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case. In this regard, indicate whether the inability to provide a definitive opinion is due to a need for further information or because the limits of medical knowledge have been exhausted regarding the etiology of the disability at issue or because of some other reason. DELYVONNE M. WHITEHEAD Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Ko, Associate Counsel