Citation Nr: 18153356 Decision Date: 11/27/18 Archive Date: 11/27/18 DOCKET NO. 16-27 514A DATE: November 27, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran honorably served on active duty from July 1971 to July 1974 and from September 1977 to September 1981. This matter is before the Board of Veteran’s Appeals on appeal from a September 2014 decision of the Department of Veterans Affairs (VA) Regional Office in St. Petersburg, Florida. 1. Entitlement to service connection for obstructive sleep apnea is remanded. VA is required to provide an examination when there is insufficient medical evidence to decide the claim, but the record otherwise contains competent evidence of a current disability or recurrent symptoms, evidence of an in-service event, and evidence of an indication of a nexus. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006); 38 C.F.R. § 3.159(c )(4)(i). The Veteran has a current diagnosis of obstructive sleep apnea. See 2013 VA medical records. The Veteran stated that he believes his sleep apnea is related to his service due to inhaling various odors while overseeing burn pits. See 2015 Notice of Disagreement. The Veteran has met the elements of McClendon, yet has not been provided a medical examination or a medical opinion regarding the cause of the Veteran’s diagnosed sleep apnea. Therefore, an examination and opinion is required to determine if his obstructive sleep apnea is related to service. Also, the Veteran asserts that VA medical personnel diagnosed with obstructive sleep apnea within a year of his separation. See 2015 Notice of Disagreement. There are no VA treatment records confirming this assertion. Nevertheless, as the case is being remanded, another attempt must be made to obtain any outstanding VA treatment records, to include any records dates in the years immediately following his separation. The matter is REMANDED for the following action: 1. Obtain the Veteran’s relevant treatment records from September 1981 to the present. 2. Send the Veteran a letter asking him to identify the VA facility that diagnosed him with obstructive sleep apnea and any other providers of private treatment relevant to this appeal, to include any years immediately following his separation. Request any adequately identified records for association with the claims file. 3. Schedule the Veteran for an examination by an appropriate examiner to evaluate the nature and cause of the Veteran’s sleep apnea. The claims file and a copy of this remand must be provided to the examiner for review. Any indicated tests or studies should be completed. Based on examination of the Veteran and review of his claims file, the examiner should provide an opinion that responds to the following: Is it as least as likely as not (a 50 percent or better probability) that the Veteran’s sleep apnea was incurred in or is otherwise related to the Veteran’s service? The examiner should specifically consider and address (a) the Veteran’s reported symptoms and their onset and (b) the Veteran’s 2015 statement regarding his exposure to burn pits. In addition, although sleep apnea is often diagnosed by overnight polysomnogram (sleep study), the Board notes that several other clinical predictors of sleep apnea have been developed, including questionnaires such as the STOP-BANG, a validated screening tool for sleep apnea (See, e.g. “STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea” published in the peer-reviewed medical journal Chest in March 2016 at 149(3):631-8 (noting 8 clinical predictors of sleep apnea, including Snoring, Tiredness during the day, Observed apnea during sleep, high blood Pressure, BMI (Body Mass Index) greater than 35 kg/m2, Age over 50 years, Neck circumference greater than 40 cm, and male Gender)). Therefore, while reviewing the claims file, the examiner should consider whether any clinical indicators of sleep apnea were present during service or any time after service but before sleep apnea was formally diagnosed. The examiner should identify any such clinical indicators and explain whether they might support a retrospective sleep apnea diagnosis. [CONTINUED ON NEXT PAGE] A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Bryant, Law Clerk