Citation Nr: 18149007
Decision Date: 11/08/18	Archive Date: 11/08/18

DOCKET NO. 18-37 245
DATE:	November 8, 2018
REMANDED
The claim of entitlement to service connection for sleep apnea is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1985 to January 2006.  Service in Southwest Asia is indicated by the record.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Togus, Maine.
The claim of entitlement to service connection for sleep apnea is remanded.
The Veteran asserts entitlement to service connection for sleep apnea, which he contends initially manifested during his military service.  See, e.g., the Veteran’s VA Form 9 dated June 2018.  The Board notes that the Veteran has also asserted that his sleep apnea is a progression of his breathing difficulties, to include service-connected asthma.  See the Veteran’s statement dated April 2014.
The Veteran’s service treatment records include a December 2005 Report of Medical History, in which the Veteran endorsed asthma/breathing problems related to exercise, weather, pollens, etc.  He also indicated that he experienced shortness of breath, bronchitis, wheezing or problems with wheezing, and had been prescribed an inhaler.
Post-service treatment records dated in March 2009 documented the Veteran’s loud snoring.  He was diagnosed with sleep apnea by sleep study in November 2013.
The Veteran has not been afforded a VA medical opinion as to the etiology of the diagnosed sleep apnea.  The Board finds that this matter must be remanded to afford the Veteran a VA medical opinion to address the outstanding questions of etiology including whether diagnosed sleep apnea was incurred during military service, or is caused or aggravated by service-connected asthma.
The matter is REMANDED for the following action:
1. The RO should arrange to obtain from an appropriate VA examiner an opinion addressing the etiology of diagnosed sleep apnea based on claims file review, if possible.  If an examination is deemed necessary in the judgment of the physician designated to provide the opinion, one should be arranged.
With respect to the diagnosed sleep apnea, the examiner should render an opinion, consistent with sound medical judgment, addressing whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the disability:
(a) had its onset in service or is otherwise medically related to in-service injury or disease; or, if not, 
(b) was either caused OR is or has been aggravated by his service-connected asthma disability.
If aggravation by service-connected disease is found, the examiner should also indicate the extent of such aggravation by identifying the baseline level of disability.  This may be ascertained by the medical evidence of record and by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time.
In addressing the above, the examiner should consider and discuss all pertinent evidence including lay evidence.  In this regard, the examiner should note that the absence of evidence of treatment for a claimed disability in the Veteran’s service treatment records should not serve as the sole basis for a negative opinion.
(Continued on the next page)
 
The examiner is also advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions.  All examination findings/testing results (if any), along with a complete, clearly-stated rationale for the conclusions reached, must be provided.
 
CHRISTOPHER MCENTEE
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. K. Buckley, Counsel