Citation Nr: 18150744 Decision Date: 11/16/18 Archive Date: 11/15/18 DOCKET NO. 16-40 578A DATE: November 16, 2018 REMANDED The claim of entitlement to service connection for sleep apnea only as secondary to service-connected post-traumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1968 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for sleep apnea Remand is required for an adequate medical opinion that addresses the Veteran’s claim. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2018). VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with an examination. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). In an August 2016 submission, the Veteran stated that he was only asserting service connection on a secondary basis - he alleges his sleep apnea is caused or aggravated by his service-connected PTSD. In March 2015 VA received a disability benefits questionnaire for sleep apnea completed by the Veteran’s private provider. Other than diagnosing sleep apnea, the provider discussed multiple sleep difficulties, some involving the Veteran’s PTSD and associated nightmares. The provider opined that the Veteran’s obstructive sleep apnea is more likely than not aggravated by his PTSD. No accompanying rationale was provided. As such, the opinion is inadequate to support a finding that obstructive sleep apnea is secondarily related to the Veteran’s PTSD. However, because there is evidence of currently diagnosed disability and an indication that that condition may be caused or aggravated by a service-connected disability, remand for a VA examination is required. The matter is REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, provide the Veteran an examination regarding the etiology of the sleep apnea from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. The examiner must provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the obstructive sleep apnea is caused or aggravated by the Veteran’s service-connected PTSD. The examiner must specifically address the private questionnaire received in March 2015 that shows the Veteran’s private treatment provider opining that the Veteran’s PTSD aggravated his obstructive sleep apnea. 4. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655 (2017). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Steve Ginski, Associate Counsel