Citation Nr: 18155962 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 18-09 220 DATE: December 6, 2018 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1984 to March 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). OBSTRUCTIVE SLEEP APNEA is remanded. The Veteran asserts that she has obstructive sleep apnea that is the result of service. Service treatment records (STRs) reflects complaints of and treatment for headaches. Post-service treatment records reflect a diagnosis of obstructive sleep apnea in November 2015. The Veteran was afforded a VA examination in April 2016. She was again diagnosed with obstructive sleep apnea. The examiner was asked to opine whether the Veteran’s sleep apnea is at least as likely as not proximately due to or the result of her migraine headaches. The examiner opined that the claimed condition is less likely than not proximately due to or the result of the Veteran’s service-connected condition. The examiner reasoned that there was no medical plausible relationship on how migraines can cause sleep apnea and that “the reality is that it is more likely that sleep apnea caused her migraines, not vice versa.” The examiner also stated that the Veteran expressed that her claim was filed incorrectly and she meant to file a claim for direct service connection, asserting that her migraines were caused by her sleep apnea. No opinion was provided regarding direct service connection. In her June 2017 notice of disagreement (NOD), the Veteran expressed that while there is no record of treatment, diagnosis, or complaints of sleep apnea during active duty, STRs reflect complaints, treatment, or diagnosis of migraines that were caused by lack of sleep. She stated that she was not treated or tested for sleep apnea on active duty. The Veteran has also submitted several lay statements by her husband and fellow service members who have attested to her being tired, missing work to get rest, and falling asleep during work hours. In addition, it was expressed that the Veteran complained of having migraine headaches, which she stated were due to lack of rest or an inability to sleep. Based on the above, the Board finds that an addendum opinion, which addresses direct service connection is required. The matter is REMANDED for the following action: Return the claims file, to include a copy of this remand, to the April 2016 VA examiner for an addendum opinion concerning the nature and etiology of the Veteran’s obstructive sleep apnea. If the examiner who conducted the April 2016 examination is unavailable, the opinion should be rendered by another appropriate medical professional. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The examiner must opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s obstructive sleep apnea was caused by or is etiologically related to any incident of active duty. In rendering the opinion, the examiner is asked to consider the numerous buddy statements of record that attest to the Veteran being tired, missing work to get rest, and falling asleep during work hours while she was in the service. The examiner should also consider the Veteran’s reported complaints of having migraine headaches, which she stated were due to lack of rest or an inability to sleep. The examiner must also opine as to whether it is at least as likely as not that the headaches that are documented in service are the initial manifestations of the onset of the Veteran’s sleep apnea. The examiner must provide reasons for each opinion. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. The examiner is advised that the Veteran is competent to report her symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. The absence of evidence of treatment for obstructive sleep apnea in the Veteran’s service treatment records cannot, standing alone, serve as the basis for a negative opinion. If the examiner rejects the Veteran’s reports, the examiner should provide a reason for doing so. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Gordon, Associate Counsel