Citation Nr: 18155281
Decision Date: 12/04/18	Archive Date: 12/03/18

DOCKET NO. 16-61 035
DATE:	December 4, 2018
REMANDED
The claim of entitlement to service connection for sleep apnea is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1972 to June 1979 and from April 1981 to June 1994.
The claim of entitlement to service connection for sleep apnea is remanded.
This claim requires additional development.  The current medical examination opinions are inadequate for adjudication.  The November 2014 VA examination opinion does not provide sufficient explanation for the negative opinion.  The December 2015 VA examination opinion does not address whether the Veteran’s pulmonary embolism aggravates sleep apnea.  Neither examination opinion addressed a direct relationship.  On remand, an updated VA medical opinion shall be obtained.
The matter is REMANDED for the following action:
1. Obtain updated VA treatment records.
2. Thereafter, obtain a VA medical opinion that addresses whether it is as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea is related to his service.  The examiner is asked to review the file and to conduct a search of the relevant literature prior to opining.
The December 2015 VA examiner noted that the Veteran’s high BMS was a risk factor for sleep apnea.  The STRs document that he weighed 214 pounds at a November 1993 examination, and 230 pounds in March 1994.  The record shows he was diagnosed with sleep apnea in the early 2000’s.  The examiner is asked to provide an opinion on whether the Veteran’s sleep apnea incepted while in service or is otherwise related to service.
The Veteran asserts his pulmonary embolism is related to his sleep apnea.  The record shows he had pulmonary embolism in 1999, and that he was diagnosed with sleep apnea shortly thereafter.  The examiner is asked to address this temporal relationship.  The examiner is also asked to provide an opinion on whether the Veteran’s pulmonary embolism or thrombophlebitis of the right leg as least as likely as not caused or aggravates sleep apnea.  “Aggravate” means to cause any increase in severity that is beyond the normal progression of the disability.
The November 2014 VA medical opinion addressing a relationship between the Veteran’s GERD and hernia and his sleep apnea does not contain adequate explanation.  The examiner is asked to provide an opinion on whether GERD and hiatal hernia as least as likely as not caused or aggravates sleep apnea.  
All opinions are to be supported with explanation.  It is up to the discretion of the examiner as to whether a physical examination is required to render the requested opinions.  If so, the examiner is asked to notify the scheduling authority.  

 
Nathaniel J. Doan
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Gibson