Citation Nr: 18156684
Decision Date: 12/11/18	Archive Date: 12/10/18

DOCKET NO. 16-59 509
DATE:	December 11, 2018
REMANDED
Entitlement to service connection for sleep apnea disorder is remanded.
REASONS FOR REMAND
The Veteran had a period of active duty service from September 1981 to September 1989.
Entitlement to service connection for sleep apnea disorder
November 1981 STRs reveal that the Veteran was diagnosed and treated for an adverse reaction to a typhoid inoculation. Evidence of the claims file suggests that the Veteran was first diagnosed for sleep apnea is July 2009.  The Veteran asserts that an adverse reaction to a typhoid inoculation in-service proximately lead to his bruxism which resulted in his current diagnosis of obstructive sleep apnea. A VA medical examiner opinion is necessary to make a determination on the Veteran's claim.
The matter is REMANDED for the following action:
1. Contact the Veteran to identify any pertinent private or VA treatment records that might be outstanding and associate them with the claims file and specifically include records of any complaints, diagnosis, or treatments of an adverse reaction to a typhoid inoculation or any residuals as well as any sleep studies he may have had, to the extent not of file.  He should identify locations and approximate dates of treatment and provide any releases needed.  All attempts to obtain documents should be associated with the claims folder.
2. Deliver the records to a qualified medical examiner for an opinion.  The examiner must be given access to all records contained in Virtual VA and VBMS, and a notation must be made that review of all records has been accomplished.  After a thorough review of the medical history, the examiner is requested to prepare a detailed opinion which answers the following question:
Taking into consideration the Veteran’s STRs, lay statements, post service VA and private treatment records, and any employment health examinations, is it as likely as not (that is a probability of 50 percent or greater) that the Veteran’s November 1981 in-service diagnosis of an adverse reaction to an in-service typhoid inoculation is proximately related to or caused the onset of the Veteran’s current sleep apnea disorder. The examiner is to also discuss in detail whether the Veteran’s contention that his adverse reaction to a typhoid inoculation in-service may have caused the onset of his bruxism disorder which may be proximately related to the onset of his sleep apnea disorder.  If an examination is deemed necessary, it should be conducted.
If the examiners cannot provide any of the requested opinions, they must affirm that all procurable and assembled data was fully considered and a detailed rationale must be provided for why an opinion cannot be rendered.
3. The AOJ must ensure that the examiner’s reports comply with this remand and answers the questions presented in the request.  The AOJ must also ensure that the examiner documents consideration of the electronic claims file, including any records contained in Virtual VA and VBMS.  If the report is insufficient, the AOJ must return it to the examiner for necessary corrective action as appropriate. 
 
MICHAEL D. LYON
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	M. Elliot Harris, Associate Counsel