Citation Nr: 18147607
Decision Date: 11/05/18	Archive Date: 11/05/18

DOCKET NO. 15-33 215
DATE:	November 5, 2018
REMANDED
Entitlement to service connection for sleep apnea, to include on a secondary basis is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Army from November 1967 to November 1969.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO).
Entitlement to service connection for sleep apnea, to include on a secondary basis is remanded.
In a September 2018 Appellate Brief, the Veteran’s representative contends that the Veteran’s current diagnosed sleep apnea is caused by obesity, resulting from the medications taken for the Veteran’s service-connected asthma. 
When determining service connection, all theories of entitlement, direct and secondary, must be considered if raised by the evidence of record, applying all relevant laws and regulations. Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004). 
In this case, the Veteran was afforded a VA examination in October 2014. The examiner rendered an opinion indicating that the Veteran’s sleep apnea was less likely than not caused or aggravated by the Veteran’s service connected asthma with rhinitis. However, this opinion does not address the Veteran’s new contention regarding obesity resulting from the medication taken for his asthma; and the obesity ultimately causing sleep apnea. 
Here, the Board notes VAOPGCPREC 1-2017, in which the General Counsel's opinion held that obesity per se is not a disease (or injury) for service connection purposes, it held nonetheless that obesity may be an "intermediate step" between a service-connected disability and current disability that may be service connected on a secondary basis. VAOPGCPREC 1-2017, pp. 9-10.
In view of the foregoing, it is therefore necessary to remand this matter for the purpose of obtaining an addendum opinion, which addresses whether the medications prescribed for the Veteran’s service connected asthma contributed in any way to cause or aggravate the Veteran’s obstructive sleep apnea, including whether the Veteran became obese as a result of a service-connected disability or medication, which, in turn, caused him to develop obstructive sleep apnea. Id.
The matter is REMANDED for the following action:
1. Obtain an addendum opinion from an appropriate VA examiner for the purposes of determining the etiology of the Veteran's sleep apnea. The record and a copy of this Remand must be made available to the examiner, and he or she should note that such have been reviewed. The need for an additional examination of the Veteran is left to the discretion of the examiner selected to write the addendum opinion.
Following a review of the record, please address the following inquiries:
a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's medications that are prescribed for his service-connected asthma has caused or aggravated his obstructive sleep apnea?
b.) If the answer to a. is no, is it at least as likely as not that the Veteran’s obesity is caused by or related to the Veteran’s service-connected asthma or medication taken to treat his service-connected asthma. If so, further state whether the obesity that was a substantial factor in causing his sleep apnea and whether the sleep apnea would not have occurred but for the obesity that was caused by the service-connected asthma or the medication taken in relation to the Veteran’s asthma. 
 
K. J. ALIBRANDO
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Marsh II, Associate Counsel