Citation Nr: 18147473
Decision Date: 11/05/18	Archive Date: 11/05/18

DOCKET NO. 16-01 520
DATE:	November 5, 2018
REMANDED
Entitlement to service connection for sleep apnea is remanded.
REASONS FOR REMAND
Entitlement to service connection for sleep apnea is remanded.
The Veteran contends that his sleep apnea either began during service or that it is due to service.  The Veteran underwent a VA examination in July 2014.  The examiner found that it was less likely than not that the Veteran’s sleep apnea was incurred in service or caused by in-service complaints of tiredness, trouble sleeping, or breathing issues.  Her rationale was that although snoring is a common symptom of obstructive sleep apnea, it is also a common in the general population and it is not sufficient to establish a diagnosis of sleep apnea.   It was further noted that there were no more likely explanations for his in-service snoring, those these were not identified.
The Board finds the opinion to be inadequate because the examiner did not adequately address the symptoms reported by the Veteran and his wife.  At the Veteran’s January 2017 Board hearing, the Veteran’s wife testified that although the Veteran snored prior to service, when he returned from Iraq, the snoring was “100 times” worse than it had been prior to service.  She also testified that the Veteran woke up in the morning with headaches; that he would wake up in the middle of the night more often; and that she had to wake him up because he was gasping for air.  In a March 2017 correspondence, she also stated that when the Veteran returned from Iraq, she noticed an increase in the amount of sleepless nights.  
The July 2014 examiner’s opinion failed to distinguish between the Veteran’s numerous (and reportedly severe) symptoms, and typical snoring (which she stated is common among the general population).  Consequently, the Board finds that a new examination is warranted.  
Additionally, the service treatment records reflect that the Veteran was diagnosed with upper respiratory infections in February 2002 and October 2005.  The examiner should render an opinion on whether the Veteran’s sleep apnea is related to these infections.    
The matter is REMANDED for the following action:
Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of 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 exposure to DEET insect repellent; pesticide-treated uniforms; environmental pesticides; smoke from oil fire; smoke from burning trash and feces; vehicle or truck exhaust fumes; tent heater smoke; JP8 and other fuels; fog oils; solvents; or paints.  
The examiner must also opine whether sleep apnea is at least as likely as not related to February 2002 and/or October 2005 upper respiratory infections.  
The examiner should acknowledge that the Veteran and his wife have provided credible testimony that the Veteran’s in-service symptoms were more than routine snoring.  They stated that his snoring severely increased (got much louder) after returning from Iraq and that he woke up with headaches, and had to be woken up on occasion because he was gasping for air.  

 
 Eric S. Leboff
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Prem, Counsel