Citation Nr: 18146698
Decision Date: 10/31/18	Archive Date: 10/31/18

DOCKET NO. 15-37 286
DATE:	November 1, 2018
REMANDED
Entitlement to service-connection for sleep apnea is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1994 to February 2005. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. 
Although the Board regrets the additional delay, a remand is warranted to afford the Veteran due process and to conduct additional development regarding the claim for service connection for sleep apnea. Specifically, VA must obtain an adequate addendum opinion regarding this claim. The Veteran was provided with a VA examination in May 2013. The examiner provided a negative opinion with respect to the Veteran’s service-connection claim for sleep apnea. However, the opinion was not supported by an adequate rationale. Specifically, the opinion relies entirely on a 2002 sleep study that failed to diagnose the Veteran with any obstructive apneas. The medical history portion of the May 2013 VA examination acknowledges that the Veteran experienced severe snoring in 2002. Evidence of record also indicates that the Veteran reported difficulty breathing while sleeping in 2003. However, the examiner’s rationale for the negative opinion was merely that, “…2002 sleep studies diagnosed loud snoring without evidence of apnea…” This narrow focus ignores the fact that service-connection may be granted for any disease diagnosed after discharge, when the evidence establishes that the disease was incurred in-service. 38 C.F.R. § 3.303, (d) (2017).
When VA undertakes the effort to provide an examination, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board finds that an addendum opinion is needed to adjudicate this appeal.
The matter is REMANDED for the following action:
1. Provide the complete record to an appropriate examiner to address the cause of the Veteran’s sleep apnea. The examiner MUST indicate that the entire record has been reviewed. Based on the factual evidence of record, the examiner must provide an opinion that responds to the following:
(a) whether it is at least as likely as not (a 50% or greater chance) that the Veteran’s current sleep apnea is related to his active military service. 
In forming the opinion, the VA examiner is asked to acknowledge the Veteran’s lay statements regarding the onset of his symptoms in-service to include snoring and difficulty breathing beginning during service and after continuing after military separation.  
(b) The examiner is also asked to address whether is as least as likely as not that the Veteran’s service-connected asthma AGGRAVATED or CAUSED his sleep apnea. 
The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it.
The examiner is also reminded that, even though a sleep disability may not have been demonstrated at separation, the Veteran may still establish service-connection for the disorder by showing he now has a current sleep apnea diagnosis and by submitting evidence that his current diagnosis is related to his active military service.
 
VICTORIA MOSHIASHWILI
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. McKone, Law Clerk