Citation Nr: 18147282
Decision Date: 11/02/18	Archive Date: 11/02/18

DOCKET NO. 16-29 350
DATE:	November 2, 2018
REMANDED
Entitlement to service connection for obstructive sleep apnea is remanded.
REASONS FOR REMAND
The Veteran served on active duty from April 1976 through September 1997.
The Veteran seeks entitlement to service connection for obstructive sleep apnea.  In support of his claim, the Veteran submitted lay statements from a fellow service member and his wife stating that he had snored for many years while on active duty.  The Veteran’s wife further stated that the Veteran would have a pause in his breathing, and she would have to wake him up.  While these statements provide some evidence that the Veteran may have experienced symptoms associated with sleep apnea during active duty service, they are not competent to diagnose the Veteran with sleep apnea.  Moreover, the Veteran’s wife did not state that she noticed any episodes of apnea during the years the Veteran was on active duty.
The Veteran also submitted a nexus statement dated September 2015 from a private physician.  The physician noted that obstructive sleep apnea is influenced by aging and weight gain, and it develops and worsens over the course of an individual’s adulthood.  He explained that sleep apnea is influenced more by the anatomical structure of the patient’s airway and relaxation of the muscles during sleep.  Based on the Veteran’s clinical history, which was noted to be highly characteristic of those with obstructive sleep apnea, the physician opined it was most likely than not that the Veteran experienced symptoms and complications of obstructive sleep apnea while on active duty.
The Board does not find the September 2015 private nexus statement to be wholly adequate.  The physician did not explain how the Veteran’s medical history was “highly characteristic” of others with obstructive sleep apnea.  There is no discussion at all of the Veteran’s medical history, merely that sleep apnea generally develops over a period of time.
The Board cannot make a fully-informed decision on the issue of entitlement to service connection for obstructive sleep apnea because no VA examiner has opined whether the Veteran’s obstructive sleep apnea is etiologically related to his active duty service.
The matter is REMANDED for the following action:
1. Ask the Veteran to complete a VA Form 21-4142 for Eastlake Sleep Center and any other private treatment the Veteran identifies.  Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile.
2. DO NOT schedule the following examination until all records identified by the Veteran have been obtained, to the extent possible. 
3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any obstructive sleep apnea.  
The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the lay reports of snoring while on active duty service.  The examiner must address the lay statements from the Veteran’s wife and friend discussing his history of snoring AND the private opinion noted above.
 
MICHELLE L. KANE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Parsons, Associate Counsel