Citation Nr: 18154570 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 16-46 828 DATE: November 30, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to posttraumatic stress disorder (PTSD) with major depressive disorder and alcohol dependence, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from January1973 to January 1993. Although the Board regrets the delay, remand is required to ensure there is a complete record on which to decide the Veteran’s claim. 1. Entitlement to service connection for obstructive sleep apnea, to include as secondary to PTSD with major depressive disorder and alcohol dependence is remanded. The Veteran asserts his obstructive sleep apnea is directly related to active duty service, or in the alternative, caused or aggravated by his service-connected PTSD. The Veteran was seen for a VA examination in August 2016. The examiner opined the Veteran’s obstructive sleep apnea is less likely than not related to an in-service injury, event, or illness. The examiner noted the Veteran’s service treatment records (STRs) do not show any signs of obstructive sleep apnea and that he was not diagnosed until 17 years after service in 2010. The examiner acknowledged the statements of the Veteran’s family regarding the Veteran’s issues while sleeping in the past, but found that those statements of events were not equivalent to a diagnosis, and summarily concluded that it was not likely that the current obstructive sleep apnea first manifested on active duty. However, the Board finds this opinion is not adequate to address why the Veteran’s family’s statements did not demonstrate a manifestation of obstructive sleep apnea during active service. In particular, the lay statements of record document various sleep symptoms that occurred while the Veteran had active service. The Veteran’s wife, H.B., stated she remembered the Veteran having problems breathing while sleeping when they were stationed in Fort Leonard Wood, Missouri. The Veteran’s son, A.M., stated he remembered his dad snoring when he was eight or nine years old in approximately 1979-1980. The Veteran’s daughter, M.F., who was born in 1985, stated she remembers her father snoring loudly and hearing choking and gasping since she was a few years old. The Veteran’s daughter, A.S., stated her father has always snored very loudly and that she saw what she believed was her father momentarily stopping breathing while sleeping. The Veteran’s son, R.M., and daughter, C.M., both stated their father began to have difficulty sleeping beginning in 1982 and would see the Veteran waking up gasping, snoring loudly, and would at times wake up choking and having trouble breathing. A medical opinion is needed to determine whether these symptoms may have reflected that the Veteran manifested obstructive sleep apnea during service. In sum, further explanation is required to fully consider the lay and medical evidence of record. The matter is REMANDED for the following actions: 1. Obtain and associate with the claims file any outstanding VA treatment records. All attempts to obtain these records should be documented in the claims file. 2. Schedule the Veteran for a VA examination with the appropriate examiner to address the nature and etiology of his obstructive sleep apnea. The examiner must review pertinent documents in the Veteran’s claims file in conjunction with the examination. This must be noted in the examination report. The examiner must obtain a thorough history of the onset of the Veteran’s sleep-related symptoms. He or she must then state: (a.) Whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s current sleep apnea had its onset in service or was otherwise etiologically related to active service. In providing this opinion, the examiner must specifically address the symptoms included in the six “buddy statements” submitted from the Veteran’s wife and children in August 2014; the statements reflected that the family members witnessed the Veteran experience difficulty sleeping, have loud snoring and choking sounds, and stop breathing during sleep since approximately 1982.   Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Laura A. Crawford, Associate Counsel