Citation Nr: 18146771
Decision Date: 11/01/18	Archive Date: 11/01/18

DOCKET NO. 16-41 079
DATE:	November 1, 2018
REMANDED
Service connection for sleep apnea, to include as secondary to posttraumatic stress disorder (PTSD), is remanded.
REASONS FOR REMAND
The Veteran asserts that there could be a relationship between his sleep apnea and his service in Vietnam, including his service-connected PTSD.  See August 2016 VA Form 9.  He has submitted articles supporting the existence of an etiological relationship between PTSD and sleep apnea and he has asserted that he experienced sleep problems during and after service.  See August 2016 VA Form 9; Medical Articles and Abstracts.  Although his claim in regard to a sleep disorder was addressed by prior medical opinions, to include a 2014 Disability Benefits Questionnaire, no examiner has reviewed the submitted articles or provided an opinion as to whether any current sleep disorder may be the result of, or aggravated by, PTSD.  The Board finds that remand is warranted for the provision of a new VA examination and to gather any outstanding records.
The matter is REMANDED for the following action:
1. Obtain all outstanding VA treatment records.
2. Ask the Veteran to complete a VA Form 21-4142 for any outstanding private treatment records.  Make two requests for the authorized records unless it is clear after the first request that a second request would be futile.
3. Then schedule the Veteran for a VA examination to determine the nature and etiology of any sleep disorder found to be present, including sleep apnea.  The claims file should be made available to and should be reviewed by the examiner.
For each sleep disorder diagnosed, to include sleep apnea, the examiner must opine as to whether it is at least as likely as not (a 50 percent or greater probability) that such disorder: 
(a) had its onset during active duty or is otherwise related to the Veteran’s service, to include as a result of herbicide exposure;
(b) is proximately due to the Veteran’s service-connected PTSD; or 
(c) has been aggravated (worsened) beyond a natural progression by the Veteran’s service-connected PTSD.
In addressing these questions, the examiner should discuss: (1) the medical treatises and articles referenced in the Veteran’s August 2016 VA Form 9, as well as those medical articles and abstracts that he submitted in August 2016; and (2) the relationship, if any, between the Veteran’s sleep apnea and his PTSD.
A complete rationale must be provided for all opinions expressed.  Please provide a separate opinion for each sub-part of the question.  If a requested opinion cannot be provided without resorting to speculation, the examiner should so state and explain why this is the case.  

 
JEBBY RASPUTNIS
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	D.M. Badaczewski, Associate Counsel