Citation Nr: 18151014
Decision Date: 11/16/18	Archive Date: 11/16/18

DOCKET NO. 16-05 035
DATE:	November 16, 2018
REMANDED
Entitlement to service connection for sleep apnea, to include as secondary to service-connected bronchial asthma and/or to service-connected post-traumatic stress disorder (PTSD) is remanded.
REASONS FOR REMAND
The Veteran had active service in the United States Marine Corps from November 1974 to October 1990. 
This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a November 2014 Rating Decision by the Department of Veterans Affairs (VA) Regional Office in Portland, Oregon.  
In an April 2015 rating decision, service connection for PTSD was granted.  In the January 2016 statement of the case (SOC), the issue of service connection for sleep apnea was expanded to include secondary to the now service connected PTSD.  The Board notes that while the January 2016 SOC included other issues, in his February 2016 VA form 9, the Veteran limited his appeal specifically to the issue of entitlement to service connection for sleep apnea.  

1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected bronchial asthma and/or to service-connected PTSD is remanded.
The Veteran seeks service connection for sleep apnea, which he maintains is secondary to one or both of his service-connected disabilities, bronchial asthma and PTSD. Records of post-service private medical treatment contained in the claims file show that the Veteran received a diagnosis of “obstructive sleep apnea” in January 2011.  In a November 2014 VA examination report, the VA examiner opined that the Veteran’s sleep apnea was less likely as not due to or permanently aggravated beyond its natural progression by his asthma.  The basis was that the weight of the literature does not support a causal or aggravating relationship between sleep apnea and asthma.  However, the examiner did not address whether service connection was warranted on a direct basis.  Further, as the Veteran is now service-connected for PTSD, which is part of the basis for the secondary claim, a new VA examination and opinion is warranted.  
When VA undertakes to provide a medical examination or obtain a medical opinion in developing a claim for benefits, it must ensure that the resulting examination or opinion is adequate for the purposes of the decision to be made. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).  
The matter is REMANDED for the following action:
1. Schedule the Veteran for a new VA examination, with an appropriate medical professional, to determine the relationship, if any, between his sleep apnea and service, or his service-connected bronchial asthma or service-connected PTSD.  The VA examiner must review the Veteran’s entire claims file, to include all medical records there and a copy of this REMAND, and that review must be noted in the report.  A complete account of onset and symptoms of his sleep apnea should be elicited from the Veteran..  
All tests should be performed that could be helpful to a medical determination of these possible relationships. 
Direct the VA examiner to provide an opinion with respect to the following:
(a) Whether it is at least as likely as not (50 percent probability or greater) that his sleep apnea had its onset in or is otherwise related to service.
(b)Whether it is least as likely as not (50 percent probability or greater) that his sleep apnea is related to or is aggravated by his service-connected asthma and/or to his PTSD.
A clear rationale for all opinions must be set forth in the examination report. 
2. Then readjudicate the claim.  If the claim remains denied, issue a Supplemental Statement of the Case (SSOC).  Then return the case to the Board.
 
Lesley A. Rein
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Pitts,  Associate Counsel