Citation Nr: 18146478 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 16-31 619 DATE: November 1, 2018 REMANDED Entitlement to service connection for sleep apnea (snoring) is remanded. Entitlement to service connection for narcolepsy is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1993 to May 2014. This appeal to the Board of Veteran’s Appeals (Board) arose from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office. The Veteran has perfected a timely appeal. See March 2016 Notice of Disagreement; June 2016 Statement of the Case (SOC); June 2016 Substantive Appeal (VA Form 9). 1. Entitlement to service connection for sleep apnea (snoring) is remanded. After a thorough review of the Veteran's claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claim of entitlement to service connection for sleep apnea (snoring). In the Veteran’s service treatment records from 2008 to 2013, it is noted that the Veteran made several complaints regarding his sleeping troubles, such trouble falling or staying asleep and tiredness throughout the day. The Veteran was receiving medication to help treat those sleeping disturbances. He was also warned about the effects of the medication causing sleeping disturbances and drowsiness. A letter from the Veteran’s medical doctor dated October 2015 specified that the Veteran was diagnosed with mild obstructive sleep apnea in August 2015. In the November 2015 VA examination, the examiner reviewed the Veteran’s claims file at the time, absent the private medical records discussed previously. The examiner opines that it is less likely as not that the Veteran had sleep apnea while in service. The examiner notes that the Veteran was recently diagnosed with obstructive sleep apnea. The examiner stated that the in-service records were silent for him having signs or symptoms for sleep apnea. The examiner notes the frequent complaints of sleeping problems, stating that it was described as insomnia, which is not consistent with a history of obstructive sleep apnea. The examiner states that he questions the current diagnosis of sleep apnea because no other information was provided. The examiner further opines that the physician that signed the letter does not indicate if she is board certified in sleep medicine. The examiner states that since the diagnosis was made post-service, it would be mere speculation to date the onset of the condition. The private medical records from August 2015 to November 2015, received June 2016, show that the Veteran was diagnosed with sleep apnea. The records also show sleep studies conducted regarding the Veteran’s sleeping issues. In the March 2016 NOD, regarding his sleep apnea, the Veteran contends that he stops breathing and have more than four episodes an hour. He states that is he uses a continuous positive airway pressure (CPAP) machine. The Board notes that the VA examiner from the November 2015 examination questioned the Veteran’s current diagnosis of sleep apnea, which may have influential in the formation of the remaining medical opinion. Therefore, due to the subsequent submission of the private medical records from August 2015 to November 2015, further proving that the Veteran has a current diagnosis of sleep apnea, a remand is necessary in order to obtain an addendum opinion that includes the review of the private medical records. 2. Entitlement to service connection for narcolepsy is remanded. After a thorough review of the Veteran's claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claim of entitlement to service connection for narcolepsy. A VA examination was not conducted regarding the Veteran’s claimed narcolepsy because there was no evidence of record establishing a current diagnosis of narcolepsy. Private medical records that were subsequently submitted do establish a current diagnosis of narcolepsy with cataplexy. The Veteran was diagnosed with narcolepsy with cataplexy in August 2015. In the March 2016 NOD, regarding his claimed narcolepsy, the Veteran contends that he had a history of sleeping issues while in service. He states that he thought he was tired all of the time due to the sleep apnea, until his private doctor conducted a sleep study. Based on the evidence of the record that establishes a current diagnosis of narcolepsy, and in-service complaints regarding sleep problems, the Board finds that a VA examination is necessary in accordance with McClendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any pertinent treatment records for his claimed disabilities of sleep apnea and narcolepsy. The RO/AMC should secure any necessary authorizations. 2. Additionally, all updated VA treatment records should be obtained. If any requested outstanding records cannot be obtained, the Veteran should be notified of such. 3. Once all available, relevant medical records have been received, and associated with the claims file, the AOJ should refer the Veteran's entire claims file to a medical professional of appropriate expertise to provide an addendum opinion (or, if the VA examiner determines that it is necessary, schedule the Veteran for a VA examination) to address the nature and etiology of the Veteran’s diagnosis of sleep apnea. The claims file and a copy of this REMAND should be made available to the examiner for review. 4. Schedule the Veteran for a VA examination to determine the nature and etiology of his narcolepsy. Any and all indicated evaluations, studies, and tests deemed necessary by the examiner should be accomplished. The claims file should be made available to the examiner for review. After record review and examination, the VA examiner should offer his or her opinion with supporting rationale as to the following inquiries: (a) Does the Veteran have a current diagnosis of sleep apnea and/or narcolepsy? (b) If the answer to (a) is yes, is it at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea and/or narcolepsy were incurred in, caused by, or etiologically related to the Veteran's service? The examiner should address the in-service complaints of sleep problems when rendering his or her opinion. The basis for each opinion is to be fully explained with a complete discussion of the pertinent lay and medical evidence of record and sound medical principles, including the use of any medical literature or studies, which may reasonably explain the medical analysis in the study of this case. All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Syesa Middleton, Associate Counsel