Citation Nr: 18150321
Decision Date: 11/15/18	Archive Date: 11/14/18

DOCKET NO. 16-34 682
DATE:	November 15, 2018
REMANDED
Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded.
REASONS FOR REMAND
The Veteran served honorably in the United States Marine Corps from June 2004 to June 2008.  This appeal is before the Board of Veterans’ Appeals (Board) from a June 2015 decision by the Department of Veterans Affairs (VA) Regional Office (RO).
VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service; and the record does not contain sufficient information to make a decision on the claim.  38 U.S.C. § 5103A (d) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006).  The threshold for finding a link between current disability and service is low.  Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon v. Nicholson, at 83.

Accordingly, additional evidentiary development is required prior to the Board rendering a decision on the issue currently on appeal.  Specifically, further medical evidence is required to determine whether the Veteran’s diagnosed obstructive sleep apnea is secondary to his service-connected PTSD.
The matter is REMANDED for the following action:
1. Obtain any outstanding VA treatment records and associate them with the Veteran’s electronic claims file.  Any negative response received should be associated therewith.
2. Thereafter, please arrange for a supplemental medical opinion to address the etiology of the Veteran’s claimed obstructive sleep apnea and ask the clinician to respond to the following questions:
Is it at least as likely as not (50 percent probability or greater) that the Veteran’s obstructive sleep apnea was caused by a service-connected disability?  Please consider and discuss as necessary the Veteran’s service-connected PTSD and its expressed symptoms.
Is it at least as likely as not that the Veteran’s sleep apnea was aggravated (permanently worsened) by a service-connected disability?  Please consider and discuss as necessary the Veteran’s service-connected PTSD and its expressed symptoms.
The claims file should be made available to and reviewed by the clinician.  All indicated tests and studies should be undertaken.  The clinician must explain the rationale for all opinions rendered, citing to supporting factual data and/or medical literature, as appropriate.
The clinician is informed that aggravation is defined for legal purposes as a chronic worsening of the underlying disorder versus a temporary flare-up of symptoms, beyond its natural progression.  If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of sleep apnea (i.e., a baseline) before the onset of the aggravation. 
3.  Finally, please readjudicate the claim.  If the claim remains denied, issue an appropriate supplemental statement of the case and afford the Veteran and his representative the opportunity to respond.  The case should then be returned to the Board, if in order, for further review.
The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded.  Kutscherousky v. West, 12 Vet. App. 369 (1999).





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This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner.  38 U.S.C. §§ 5109B, 7112 (2012).
 
K. A. KENNERLY
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Stuedemann, Associate Counsel