Citation Nr: 18152477
Decision Date: 11/23/18	Archive Date: 11/23/18

DOCKET NO. 14-01 620
DATE:	
November 23, 2018
REMANDED
Entitlement to service connection for sleep hypopnea, to include as secondary to service-connected cervical paravertebral trapezius myositis, right C5-C6 radiculopathy, and as secondary to medications taken for service-connected disabilities, is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 1995 to July 2000.  This matter comes before the Board of Veterans’ Appeals (Board) from a February 2013 rating decision.  In February 2018, the Board remanded the appeal for additional development.
Entitlement to service connection for sleep hypopnea, to include as secondary to service-connected cervical paravertebral trapezius myositis, right C5-C6 radiculopathy, and as secondary to medications taken for service-connected disabilities is remanded.
The Veteran contends that his sleep hypopnea disability was caused or aggravated by his service-connected cervical spine disability and/or by medications taken for his service-connected disabilities.  In December 2009, he was diagnosed with sleep hypopnea during a fee-basis examination after being referred by his VA neurologist.  His service-connected disabilities include a mood disorder due to cervical spine discogenic disease and chronic pain syndrome with depressive features, a migraine headache disability, a cervical spine disability, dyshidrotic eczema, tinnitus, peripheral vestibular disorder, gastroesophageal reflux disease (GERD), and erectile dysfunction.
While the Veteran has asserted that his sleep hypopnea disability is secondary to his service-connected cervical spine disability and/or secondary to medications taken for his service-connected disabilities, he also submitted several lay statements from family members, who attested to witnessing the Veteran snoring and choking in his sleep since separation from service.  The medical opinions of record address only the issue of secondary service connection.  
In addition, the Board requires a supplemental medical opinion regarding the issue of secondary service connection.  In July 2012, the Veteran submitted internet fact sheets regarding sleep apnea, including one advising that alcohol and sedative medications such as certain sleeping pills, muscle relaxants, anti-anxiety drugs, and narcotics can cause sleep apnea to occur or cause sleep apnea to be more dangerous.  Unfortunately, the VA medical opinion provided in May 2018 did not adequately address medications the Veteran was taking for service-connected disabilities prior to his sleep hypopnea diagnosis in December 2009.  Therefore, on remand, the agency of original jurisdiction (AOJ) should obtain a supplemental medical opinion as to the likelihood that the Veteran’s sleep hypopnea had its onset during military service or was caused or aggravated by medications taken for service-connected disabilities.
The matter is REMANDED for the following action:
Provide the Veteran’s electronic claims file to a VA clinician to obtain an opinion as to the etiology of the Veteran’s sleep hypopnea.  
Following a review of the claims file, the reviewing clinician should provide an opinion, with supporting rationale, as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s sleep hypopnea (1) had its onset in service or is medically related to any disease or injury in service, OR (2) was, or is, aggravated by any medications prescribed for service-connected disabilities (including cyclobenzaprine, Tramadol, tizanidine, lorazepam, quetiapine fumarate, zolpidem, or others) since separation from service.  
A complete medical explanation must be provided for all opinions expressed.  In providing the requested opinion and rationale, the clinician should consider lay statements from the Veteran’s family members attesting to observing him snore and awake choking since separation from service.  The examiner should also address whether any medications the Veteran has taken for service-connected disabilities cause respiratory depression.  
 
If the clinician determines that an examination is necessary to provide the requested opinion, one should be scheduled.



 
K. Conner
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Kirscher Strauss, Counsel