Citation Nr: 18146441 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-31 387 DATE: October 31, 2018 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to the service-connected asthma, chronic bronchitis, and reactive airway dysfunction syndrome as well as the service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 1984 to March 1986 and from November 2009 to October 2010. The case is before the Board of Veteran’s Appeals (Board) on appeal from a June 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for sleep apnea, to include as secondary to the service-connected respiratory disorder and PTSD is remanded. The Veteran asserts that his sleep apnea is caused or aggravated by his service-connected respiratory and psychological disorders. In June 2015, the Veteran was afforded a VA examination. The VA examiner concluded that, although the respiratory disorders the Veteran was claiming to have caused his sleep apnea, have an effect on the same organ (respiratory system), there was no evidence that the currently service-connected disorders caused or increased the risk of sleep apnea. The etiological opinion provided that the Veteran’s sleep apnea is less likely as not due to service, and his post service diagnosis of sleep apnea is less likely as not a disability pattern or diagnosed disease is related to a specific exposure event experienced by the Veteran during service. The examiner concluded that the Veteran’s current sleep apnea is less likely as not proximately due to or the result of the service-connected asthma, chronic bronchitis or reactive airway dysfunction syndrome. See also the June 2016 addendum opinion. Although the VA examiner provided an opinion as to causation, the examiner did not address the theory of aggravation. Remand is required so that a VA medical addendum opinion may be obtained. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (holding that the Board errs in relying on a medical opinion that only addresses whether a nonservice-connected claim is "related to" a service-connected disability and the opinion does not address whether the nonservice-connected disability is aggravated by a service-connected disability). Additionally, the Veteran has also been service-connected with PTSD and raised that his claimed sleep apnea is secondary to the service-connected PTSD, in addition to the other service-connected respiratory disorders. However, the Veteran has not been afforded a VA examination to assess whether his sleep apnea was caused or aggravated as a result of the service-connected PTSD. Thus, a new VA examination will be required to determine whether the Veteran’s claimed sleep apnea was caused or aggravated by the service-connected PTSD. The matter is REMANDED for the following action: 1. Obtain all outstanding VA clinical records and give the Veteran the opportunity to identify any private treatment records for association with the claims file. All records/responses received must be associated with the claims file. 2. Obtain an addendum medical opinion from the June 2015 VA examiner (or, if unavailable, from a medical professional with appropriate expertise). The examiner should review the Veteran's claims file, including a copy of this remand, and comment on the following questions: (a) Is it at least as likely as not (i.e., probability of 50 percent or higher) that the Veteran’s sleep apnea is proximately due to or the result of the Veteran’s service-connected respiratory disabilities and/or service-connected PTSD? (b) If the answer to (a) is negative, is it at least as likely as not that the sleep apnea is aggravated (i.e., permanently or temporarily worsened) by the service-connected respiratory disabilities and/or service-connected PTSD? If aggravation is found, the examiner should address the following medical issues: 1) the baseline manifestations of the disorder found prior to aggravation; and 2) the increased manifestations which, in the examiner’s opinion, are proximately due to the service-connected disorder(s). (c) Is it at least as likely as not (i.e., probability of 50 percent or higher) that the sleep apnea is proximately due to or the result of the Veteran’s service-connected respiratory disabilities and/or service-connected PTSD? Additionally, the VA examiner should review and comment on whether he/she agrees with the medical conclusions of Dr. J.S.’s opinion in the April 2015 Disability Benefits Questionnaire. See the April 2015 3. The examiner must provide all findings, along with a complete rationale for his or her opinion in the examination report. If the opinion requested above cannot be provided without resort to speculation, the examiner must so state and whether additional information is required. 5. After accomplishing any additional development deemed appropriate, readjudicate the claim on appeal. If the benefit sought in connection with the claim remains denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case (SSOC) and given the opportunity to respond and appropriate period should be allowed before the record is returned to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Khan, Associate Counsel