Citation Nr: 18151130
Decision Date: 11/16/18	Archive Date: 11/16/18

DOCKET NO. 12-00 697
DATE:	November 16, 2018
REMANDED
Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded.
REASONS FOR REMAND
The Veteran served on active duty from August 1982 to August 2002.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).
In November 2014, the Board denied service connection for sleep apnea, to include as secondary to the Veteran’s service-connected PTSD.  The Veteran appealed the November 2014 Board decision to the United States Court of Appeals for Veterans Claims (Court).  In an October 2015 Memorandum Decision, the Court vacated the Board’s November 2014 decision with regard to the aforementioned claim and remanded the case to the Board for development consistent with its decision.  In February 2016, the Board remanded the claim for additional development consistent with the Court’s instructions.
In May 2017, the Board again denied the Veteran’s claim.  The Veteran appealed the May 2017 Board decision to the United States Court of Appeals for Veterans Claims (Court).  In a June 2018 Memorandum Decision, the Court vacated the Board’s May 2017 decision with regard to the aforementioned claim and remanded the case to the Board for development consistent with its decision.  
1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected PTSD, is remanded.
The June 2018 Memorandum Decision determined that the Board erred when it relied on inadequate July 2016, January 2017, and February 2017 VA medical opinions to determine that the Veteran’s sleep apnea was not aggravated by his service-connected PTSD.  Specifically, the July 2016 opinion provided an incomplete rationale as it failed to address how the term association differs from aggravation.  Further, the January and February 2017 opinions failed to address aggravation or adequate address the August 2011 positive private medical opinion.  In accordance with the June 2018 Memorandum Decision, the Board finds that a new VA opinion is warranted regarding whether the Veteran’s sleep apnea is aggravated by his PTSD.
The matter is REMANDED for the following action:
1. Obtain all outstanding VA treatment records.
2. With any necessary assistance from the Veteran, obtain all outstanding private treatment records.  If any records are unavailable, notify the Veteran pursuant to 38 C.F.R. § 3.159(e).
3. Then obtain an addendum opinion from an examiner other than the February 2017 examiner regarding the etiology of the Veteran’s obstructive sleep apnea.  No additional examination is necessary, unless the examiner determines otherwise.  After a review of the claims file, the examiner is requested to provide a specific opinion as to the following:
Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s obstructive sleep apnea is aggravated (worsened beyond natural progression) by his service-connected PTSD.
The examiner must specifically address 1) the undated medical letter from Dr. H.J.; 2) the August 2011 private etiological opinion from Dr. E.H.; 3) the prior October 2011, July 2016, January 2017, and February 2017 VA medical opinions; and 4) the articles submitted by the Veteran.  
If the examiner determines that there is a higher “association” and/or “contribution” of obstructive sleep apnea with PTSD, he or she must address how association and/or contribution differs from aggravation.  Please note that factors contributing to a disorder do not rule out the possibility that it was also aggravated to some degree by service-connected disabilities.  See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013).
 
S. BUSH
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	K. Forde, Counsel