Citation Nr: 18146857
Decision Date: 11/01/18	Archive Date: 11/01/18

DOCKET NO. 16-38 468
DATE:	November 1, 2018
REMANDED
Entitlement to service connection for obstructive sleep apnea (OSA) is remanded.
REASONS FOR REMAND
The Veteran served on active duty from June 2005 to June 2010.
At the time this appeal was initiated, the Veteran was represented by Disabled American Veterans (DAV).  Subsequently, in June 2016, the Veteran revoked DAV’s representation and submitted another VA Form 21-22a in which he designated Robert A. Friedman as his representative. Therefore, the Board recognizes this change in representation.
Entitlement to service connection for a OSA is remanded.
The Veteran contends that his OSA, which was diagnosed in March 2016, is related to his service-connected posttraumatic stress disorder (PTSD).  In April 2016, the Veteran underwent a VA examination for sleep apnea.  The VA examiner opined that the Veteran’s OSA is less likely than not a result of his service-connected PTSD as there was no evidence to support the correlation between the two diagnoses.  The examiner noted that the most common cause of OSA is excessive weight gain.  The examiner found that the Veteran weighed 190 pounds at discharge and weighed 222 pounds at the time he was diagnosed with OSA.  The examiner opined that the etiology of current OSA is more likely than not is related to the obstruction in the upper airways due to adipose tissue which correlates to the weight gain that has progressed.  The Veteran’s service treatment records (STRs) revealed that the Veteran weighed 187 pounds in 2006 and 206 pounds in 2009.  Therefore, the Board notes that the April 2016 VA examiner’s rationale appears to be flawed in that the Veteran weighed 206 pounds at discharge, not 190 pounds.  The medical evidence of record does not address whether the Veteran’s weight gain in service is etiologically related to the Veteran’s current diagnosis of OSA.  In light of the foregoing, a VA medical addendum opinion is necessary.
The matter is REMANDED for the following action:
1. Obtain a VA medical addendum opinion from the April 2016 VA examiner or a similarly qualified individual.  The examiner should review the record prior to providing an opinion.  The examiner should provide an opinion as to whether it is more likely than not, less likely than not, or at least as likely as not, that OSA is related to any in-service disease, event, or injury, to include in-service weight gain.  The examiner is requested to address the significance of the Veteran’s weight gain in service as evidence of the onset and development of OSA.  



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The examiner should note that an in-service diagnosis is not required.  The examiner should consider any lay evidence of reports of purported OSA symptoms since service.  
The examiner should provide a complete rationale for all opinions expressed and conclusions reached.
 
S. L. Kennedy
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Costello, Associate Counsel