Citation Nr: 18151548 Decision Date: 11/19/18 Archive Date: 11/19/18 DOCKET NO. 16-48 855 DATE: November 19, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served honorably in the Army from September 1986 to January 2007. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2014 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In his September 2016 substantive appeal, the Veteran requested a Board hearing before a Veterans Law Judge (VLJ). The request was withdrawn in writing in November 2016. Entitlement to service connection for obstructive sleep apnea Remand is required to secure an addendum VA opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). In his September 2016 substantive appeal the Veteran alleged his sleep apnea was secondary to his service-connected PTSD. Additionally, VA examinations in October 2014 and August 2015 showed chronic sleep impairment as a symptom of PTSD. In his February 2015 Notice of Disagreement (NOD), the Veteran alleged he was seen multiple times for sleep complaints during service. The Veteran received a VA examination in April 2014. The examiner opined that the sleep apnea was less likely than not caused by service. The examiner based this opinion on one complaint of trouble sleeping in January 1999 where the Veteran specifically denied snoring. A review of the Veteran’s service treatment records (STRs), however, showed several complaints for trouble sleeping, fatigue, low energy, night sweats, difficulty breathing, awaking tired, daytime drowsiness, and disturbed sleep. The examiner did not address the symptoms noted in the STRs. In the February 2015 NOD, the Veteran noted that he served in Desert Storm during the Gulf War and was exposed to burning fuel and smoke. An addendum opinion was provided in September 2016. The opinion provider determined it was less likely than not that the obstructive sleep apnea was due to toxin or environmental hazards incurred while serving in southwest Asia. The VA examination and addendum opinion failed to address secondary service connection and failed to adequately address direct service connection. Accordingly, remand 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, obtain an addendum opinion regarding the etiology of the obstructive 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. First, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the obstructive sleep apnea had onset in, or is otherwise related to, active service. Second, the examiner must provide an opinion regarding 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 service-connected PTSD. The examiner must specifically address the following: 1) in-service complaints of trouble sleeping, fatigue, low energy, night sweats, difficulty breathing, awaking tired, daytime drowsiness, and disturbed sleep contained in the STRs; and 2) VA examinations that showed chronic sleep impairment was a symptom of PTSD. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Bruton, Associate Counsel