Citation Nr: 18150434
Decision Date: 11/15/18	Archive Date: 11/15/18

DOCKET NO. 16-35 330
DATE:	November 15, 2018
REMANDED
Service connection for sleep apnea is remanded.
Service connection for ischemic optic neuropathy is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1970 to July 1992.
This matter comes to 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 Baltimore, Maryland.
1. Service connection for sleep apnea is remanded.
The Board cannot make a fully-informed decision on the issue of service connection for sleep apnea because no VA examiner has opined whether this condition is causally related to the Veteran’s service connected sinusitis or hypertension, in light of the medical article submittwed by the Veteran suggesting that sinusitis and/or hypertension is  related to sleep apnea.
Furthermore, there is conflicting evidence of record as to the relationship between the Veteran’s service-connected posttraumatic stress disorder (PTSD) and his sleep apnea.  In 2015, he submitted an opinion from Dr. M. that PTSD is directly related to sleep apnea, while a VA examiner opined in 2016 that it is “a medical fact” that PTSD does not cause sleep apnea.  Another VA examiner in 2016 stated there is a lack of evidence in the medical community the conditions are related.  However, the Veteran has submitted numerous treatise articles suggesting a relationship between the two conditions, and also submitted a statement in 2016 from his VA psychiatrist that there are numerous studies suggesting a correlation between these two conditions.  The opinions of record are exceedingly brief with little to no rationale, and it would be helpful to have a specialist in sleep disorders provide a detailed opinion. 
2. Service connection for ischemic optic neuropathy is remanded.
Finally, because a decision on the remanded issue of service connection for sleep apnea could significantly impact a decision on the issue of service connection for ischemic optic neuropathy, the issues are inextricably intertwined.  A remand of the claims for service connection for ischemic optic neuropathy is required.
The matters are REMANDED for the following action:
Send the Veteran’s file to a sleep study specialist for opinions as to the etiology of the Veteran’s sleep apnea.  The specialist should review the conflicting opinions of record (2015 opinion from Dr. M., two VA opinions from May 2016, and a 2016 letter from VA psychiatrist) and then opine whether it is at least as likely as not that the Veteran’s sleep apnea is:
•	proximately due to or aggravated beyond its natural progression by service-connected PTSD;  
•	proximately due to or aggravated beyond its natural progression by service-connected sinusitis; or 
•	proximately due to or aggravated beyond its natural progression by service-connected hypertension.  
It would be helpful if the specialist could provide a complete explanation, as well as any areas of agreement or disagreement with the other opinions of record, and the various treatise articles submitted by the Veteran.
 
MICHELLE L. KANE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Houbeck, Counsel