Citation Nr: 18153798 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 15-07 675 DATE: November 28, 2018 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected disability(ies), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 2000 to August 2006. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a March 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran contends that he has sleep apnea that is directly related to his active service, or as secondary to service-connected disability. See March 2013 Notice of Disagreement (NOD). The Veteran was provided with a VA examination as to his sleep apnea in February 2012. A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board’s evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here the Board finds that the February 2012 examination relating to the Veteran’s sleep apnea is inadequate for decision-making purposes. Upon examination, the VA examiner noted that the Veteran had been diagnosed with sleep apnea after a July 2011 sleep study. The examiner opined that there is no objective evidence that the Veteran has “any condition that causes or aggravates sleep apnea.” The VA examiner did not provide an opinion as to the whether the Veteran’s sleep disorder is aggravated by his many service-connected disorders. In that regard, the Board notes that an opinion to the effect that one disability “is not caused by or a result of” another disability does not answer the question of aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). Because the July 2011 VA examination is inadequate for decision-making purposes, the issue must be remanded for a further VA opinion. Barr, 21 Vet. App. 312. The Board notes that the Court recently held that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O’Rourke, 30 Vet. App. 74 (2018). As such, on remand, the VA examiner must provide separate findings and rationales relating to causation and aggravation. Additionally, the Board notes that the record for review may be incomplete. The most recent VA treatment records are from February 2012. VA treatment records, even if not in the claims file, are considered part of the record on appeal because they are within VA’s constructive possession. See 38 U.S.C. § 5103A (2012); Bell v. Derwinski, 2 Vet. App. 611 (1992). On remand, updated VA treatment records must be obtained and associated with the record. The matter is REMANDED for the following action: 1. Obtain all outstanding medical records relevant to the disability at issue, to include from February 2012. 2. After the above development, forward the record and a copy of this remand to the examiner who conducted the February 2012 VA examination, or if the examiner is unavailable, another suitably qualified examiner, for completion of an addendum opinion. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. Following review of the record, the examiner should express an opinion as to: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea had its onset during his active service or is otherwise etiologically related to the Veteran’s service. Rationale must be provided for the opinion proffered. (b.) If not, whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea is proximately due to or the result of his service-connected disability(ies). (c.) If not, whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea was aggravated by his service-connected disability(ies). “Aggravation” is defined as a worsening beyond the natural progression of the disease. Additionally, pursuant to Atencio, the VA examiner must provide separate findings and rationales as to whether the Veteran’s sleep apnea is caused by, or aggravated by, his service-connected disability(ies). After completion of the above, review the expanded record, including the evidence entered since the most recent statement of the case, and determine whether service connection for sleep apnea may be granted. If the benefit sought remains denied, furnish the Veteran with a supplemental statement of the case. The appropriate period should be allowed for response before the appeal is returned to the Board. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.E. Leary, Associate Counsel