Citation Nr: 18147719 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 16-32 568 DATE: November 7, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Army from August 1982 to February 1986. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In that rating decision, the RO denied service connection for sleep apnea. The Veteran appealed the rating action and the RO’s determination therein to the Board. The appeal is REMANDED to the Agency of Original Jurisdiction (AOJ). VA will notify the Veteran if further action is required. Entitlement to service connection for obstructive sleep apnea is remanded. A remand is required to have the RO schedule the Veteran for a VA examination to determine the etiology of her sleep apnea. The Veteran seeks service connection for sleep apnea. She contends that her sleep apnea was incurred in and caused by her military service. The Veteran further contends that her sleep apnea initially manifested as tiredness during the day and loud snoring, but thought it was due to the dusty new environment. A review of the Veteran’s post-service treatment records reveals that in January 2015, a VA physician diagnosed her with severe obstructive sleep apnea (OSA) after administering a sleep study. The same physician noted that during the Veteran’s sleep study, she witnessed apneas, excessive daytime sleepiness, and gasping for air during sleep. The Veteran was then given a Continuous Positive Airway Pressure (CPAP) machine. VA treatment records continued to show the Veteran’s diagnosis of OSA. The Board notes that these treatment records do not contain any conclusions or opinions as to the etiology of the Veteran’s sleep apnea, notably whether it had its initial manifestations as daytime fatigue and loud snoring, while in service, as alleged by the Veteran. The Veteran’s enlistment medical records do not show any signs or symptoms of sleep apnea. Service treatment records (STRs) also do not reveal any complaints of, or treatment for sleep apnea or related symptoms. A note in the Veteran’s STRs states that the Veteran did not report for a physical examination prior to separation from service. A lay statement from the Veteran’s spouse dated in July 2015 indicates that he observed the Veteran snoring very loudly only after entering military service and that the snoring did not occur prior to service. The Veteran also submitted lay statement dated in October 2015 from her friend, who is a registered nurse. The Veteran’s friend stated that she vacationed with the Veteran a few years prior, when she noticed that the Veteran’s snoring was not normal and that the Veteran appeared to have symptoms of sleep apnea. She further stated that the Veteran informed her that the snoring started during her military service. A July 2015 statement from a VA physician indicates that he had been treating the Veteran for sleep apnea. He noted that he reviewed the Veteran’s medical records, and he opined that it was possible that the Veteran had her sleep apnea condition when she was in the military. The Board notes that the above statement is vague and does not provide any rationale for the conclusion. However, as the Veteran has a current diagnosis of sleep apnea and has maintained that her sleep apnea initially manifested as daytime fatigue and loud snoring while in military service, with lay statement from the Veteran’s spouse indicating that the Veteran’s loud snoring started in service, the Board finds that the low threshold of McLendon has been met. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Therefore, the Veteran must be provided an examination to determine the etiology of her sleep apnea. Id. The matter is REMANDED for the following actions: 1. Obtain all clinical records, both VA and non-VA, which are not already in the claims file, pertaining to treatment of the Veteran for sleep apnea. 2. Schedule the Veteran for appropriate VA examination. The examiner must obtain from the Veteran a detailed history of the onset and progression of relevant symptoms. All indicated tests and studies should be performed and the examiner must review the results of any testing prior to completing the report. The examiner must utilize the appropriate DBQ. The examiner should state whether it is at least as likely as not (a 50 percent or greater probability), that the sleep apnea is etiologically related to service. In formulating the requested opinion, the examiner should consider the Veteran’s and her spouse’s contentions concerning the onset of what they believe were the onset of sleep apnea symptoms, and the October 2015 statement from the nurse. THOMAS H. O'SHAY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Trowers, Associate Counsel