Citation Nr: 18146413 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-39 128 DATE: October 31, 2018 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to the service-connected psychiatric disorder of depression (dysthymic disorder), is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to July 1970. This appeal comes before the Board of Veterans’ Appeals (Board) from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Board regrets further delay, but finds that additional development is necessary before a decision may be rendered on the sleep apnea service connection claim. The Veteran asserts that his sleep apnea is related to his active service and/or is secondary to his service-connected psychiatric disability. See September 2015 Notice of Disagreement (asserting that he began experiencing symptoms of sleep apnea, mainly snoring, gasping and daytime fatigue, during active duty; and that additionally, he believes that his sleep apnea has been aggravated by his service-connected psychiatric disability). Additionally, he explained that during boot camp, he was asked to participate in a medical project which studied prevention of respiratory disease in naval recruits, and that after the project was completed and he graduated from boot camp, he noticed that he had a lot of symptoms that he had not had before the study, including and not limited to, heavier breathing while jogging. He further explained that upon boarding his naval ship, fellow service members complained about his loud snoring, which kept them up at night; and that they informed him that he occasionally stopped breathing while he was asleep. He additionally reported that in July 1970, he responded to the dispensary at the U.S. Naval Station in Mayport, Florida, after having a respiratory reaction under heating conditions, with symptoms of problems breathing, continued sneezing, fatigue and trouble sleep at night, two days prior. See September 2016 Board Appeal. In support of his claim, the Veteran submitted lay statements from his wife and his brother. Specifically, his brother, R.B., reported that when the Veteran came home from leave in the military in 1969 and he noticed that the Veteran’s breathing paused while he was sleeping; and that at times, it was like as if he stopped breathing. See January 2015 Statement from R.B. His wife, O.B., explained that she knew him before he was enlisted into service, and that on his return, the symptoms she noticed included loud snoring, gasping for air during his sleep, and daytime fatigue. She indicated that these symptoms have been with the Veteran since his time in the military, and has continued throughout the years. See September 2015 Statement from O.B. The medical evidence of record entails a Disability Benefits Questionnaire (DBQ) from the Veteran’s private physician, Dr. D.R.I. This April 2014 DBQ reflects that the Veteran has a current diagnosis of sleep apnea. In private medical report, Dr. D.R.I. opined that the Veteran’s sleep apnea began while he was in military service. See April 2014 and March 2016 Medical Reports. However, Dr. D.R.I. did not provide a rationale to support the basis of his opinion. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that examinations that provide unsupported conclusions are inadequate medical examinations). Accordingly, the medical opinion, by itself, is not sufficient with which to grant the claim. The Veteran has not yet been afforded a VA examination for sleep apnea. The Veteran has not yet been afforded a VA examination for sleep apnea. Given the current diagnosis and the evidence of an in-service symptomatology, a remand is required for a VA examination and etiological opinion on sleep apnea, on a direct and secondary basis. The matter is REMANDED for the following action: 1. Obtain all outstanding medical records pertinent to the claim. 2. Schedule the Veteran for a VA examination with a physician with sufficient expertise 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 was the result of an event, illness or disease, or is otherwise related to active service. b. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea is caused by his service-connected psychiatric disability, or any other service-connected disabilities. c. Opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea has been aggravated by his service-connected psychiatric disability, or any other service-connected disabilities. “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, his wife, and brother about onset, continuity and symptomatology, including and not limited to, the Veteran’s statements pertaining to the medical project he alleges to have participated in during boot camp. 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. DELYVONNE M. WHITEHEAD Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD V-N. Pratt, Associate Counsel