Citation Nr: 18150472
Decision Date: 11/15/18	Archive Date: 11/15/18

DOCKET NO. 16-41 961
DATE:	November 15, 2018
REMANDED
Service connection for sleep apnea, to include as secondary to service connected PTSD,  is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 2005 to November 2014. 
This matter comes before the Board of Veterans’ Appeals (Board) from a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio, which denied the Veteran’s claim for service connection for sleep apnea.
Service Connection for Sleep Apnea is Remanded.
The Veteran asserts that he currently has a sleep apnea disability that had its onset during his active service, or is related to his service-connected PTSD. 
On various occasions, including the October 2013 and July 2014 service treatment records (STRs), the Veteran reported having “sleep disturbances.” In a January 2014 service treatment record, the Veteran reported having trouble falling asleep since 2007. Moreover, the Veteran’s July 2014 service treatment records show he was taking melatonin and zolpidem medications at or before “bedtime as needed for sleep.”
An August 2016 VA annua outpatient clinical assessment note from a VA nurse described the Veteran’s symptoms as “symptoms compatible with sleep apnea with snoring and gasping upon awakening.” 
The evidence of record suggests that the Veteran’s claimed sleep apnea disability may be related to in-service events; however, he has not been afforded a VA examination to determine the nature and etiology of his claimed sleep apnea disability. Accordingly, the Board finds that a remand is necessary to afford the Veteran a VA examination. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).  In addition, although sleep impairment is a symptom of PTSD, the issue of whether the Veteran has sleep apnea that is either caused or aggravated by his service connected PTSD has been raised by the evidence of record and should therefore be addressed in the medical opinion being obtained on remand.  38 C.F.R. § 3.159(c)(4)(i)(C) (VA examination warranted where the evidence indicates that a current disability may be associated with another service connected disability).
In addition, it appears that a private in-home sleep study was conducted in September 2016 but is not in the claims file.  The July 2017 supplemental statement of the case notes that VA treatment records referenced a September 2016 in-home sleep study, but the results were said to be unavailable.
The matter is REMANDED for the following action:
1. Take the appropriate action to obtain results from the September 2016 sleep study.  If the document cannot be located, prepare a memorandum to the file indicating the steps taken to locate this document.
2. Schedule the Veteran for a VA examination to determine the nature and etiology of any sleep apnea disorder. All relevant electronic records must be sent to the examiner for review. 
The examiner should first indicate whether there is a diagnosis of sleep apnea or any other sleep disorder.  Then, the examiner should indicate, for any diagnosed sleep disorder, whether: 
(a.) It is at least as likely as not (50 percent or greater) that the sleep disorder is related to the Veteran’s service, to include reports of trouble sleeping in the STRs from the end of 2013 to July 2014. 
(b.) It at least as likely as not that a sleep disorder is caused by the Veteran’s service-connected PTSD? 
(c.) Is it at least as likely as not that the sleep apnea disability is aggravated by the Veteran’s service-connected PTSD? 
The examiner must provide a complete rationale for any opinion set forth.
 
 Jonathan Hager
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Lopez, Law Clerk