Citation Nr: 18155894 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 17-02 141 DATE: December 6, 2018 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to post-traumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from June 1963 to April 1966. In November 2015, the Veteran was provided a VA examination in conjunction with his claim of entitlement to service connection for sleep apnea to include as secondary to PTSD. There, his diagnosis of sleep apnea was confirmed. The examiner determined that it was less likely than not that the Veteran’s sleep apnea was due to or the result of PTSD. He did not address whether the Veteran’s sleep apnea was aggravated by his PTSD. The examiner reasoned that PTSD was not shown in the literature to cause obstructive sleep apnea. However, the Board notes that the Veteran submitted an article prior to the VA examination relating sleep apnea to anxiety disorders, including PTSD, and submitted an additional article after the examination which also found a positive association. Additionally, VA treatment providers have noted a relationship between the Veteran’s sleep disturbances and his PTSD, but have not elaborated on this relationship. The Board finds that an addendum opinion is required which discusses the aforementioned articles and the notations in the Veteran’s treatment records, and also addresses the theory of aggravation. Further, the Board notes that since the issuance of the statement of the case (SOC) in October 2016 the Veteran submitted an additional treatise article and new VA treatment records have been associated with the Veteran’s claims file. Regarding the article that the Veteran submitted, he did not submit a waiver of Agency of Original Jurisdiction (AOJ) review; however, as the Form 9 concerning this appeal was received after February 2, 2013, a waiver is not required. See § 501, Public Law No. 112-154, 126 Stat. 1165 (amending 38 U.S.C. § 7105 to provide for an automatic waiver of initial RO review of evidence submitted to the RO or to the Board at the time of or subsequent to the submission of the substantive appeal, unless the claimant or claimant’s representative requests in writing that the RO initially review such evidence). Concerning the more recently associated VA treatment records, the Board observes that a Supplemental Statement of the Case (SSOC) must be furnished to the claimant when additional pertinent evidence is received after a Statement of the Case (SOC) has been issued. 38 U.S.C. § 7105; 38 C.F.R. § 19.31. As such, a remand is also required for the issuance of an SSOC. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. After obtaining the necessary authorization from the Veteran, obtain and associate with the claims file any identified relevant private medical records. All attempts to secure these records must be documented in the record. If any requested records are unavailable, the Veteran should be notified of such in accordance with 38 C.F.R. § 3.159 (e). 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s sleep apnea is at least as likely as not related to his service-connected PTSD or is aggravated beyond its natural progression by his service-connected PTSD disability. The examiner should specifically address the articles submitted by the Veteran, as well as the notations in his VA treatment records that suggest a relationship between the Veteran’s sleep issues and PTSD. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Bush