Citation Nr: 18157264
Decision Date: 12/13/18	Archive Date: 12/12/18

DOCKET NO. 13-06 214A
DATE:	December 13, 2018
REMANDED
The claim for service connection for obstructive sleep apnea (OSA) to include as secondary to post-traumatic stress disorder (PTSD) is remanded.
REASONS FOR REMAND
The September 2017 Board of Veterans’ Appeals (Board) remand directed that the Veteran be afforded a VA medical opinion as to whether the Veteran’s OSA was caused by or aggravated by his service connected PTSD.  This remand specifically directed that the clinician document consideration of articles submitted in support of the Veteran’s claim; however, the December 2017 medical opinion completed following this remand did not document consideration of these articles by the clinician or reference them in any manner.  Accordingly, as the Board is required to insure compliance with the instructions of it remands, this case must be remanded for an opinion that includes consideration of the articles submitted in support of the Veteran’s claim.  Stegall v. West, 11 Vet. App. 268 (1998).   
For the reasons stated above, this matter is REMANDED for the following action:
The Veteran should be afforded an addendum VA opinion, provided by a new clinician, regarding his sleep apnea.  The clinician shall note in the report that the entire electronic claims file has been reviewed. Following a review of the claims file, the clinician should offer the following opinion:
Is it at least as likely as not (50 percent probability or greater) that the Veteran’s currently diagnosed sleep apnea is caused by, secondary to, or aggravated (made permanently worse beyond the natural progression of the disease) by his service-connected PTSD?  This opinion should specifically reference consideration of the following articles listed by the Veteran’s representative in his October 2016 brief to the Board:   
1) An American Academy of Sleep Medicine (AASM) article which states that “A new study of young U.S. Veterans shows that the probability of having a high risk of OSA increases with increasing severity of PTSD symptoms.” See http://www.aasmnet.org/articles.aspx?id=5569
2) Article released by the Sleep Health Foundation verifies that “Obstructive Sleep Apnea may be caused by weight gain due to the life style changes associated with PTSD.” See https://www.sleephealthfoundation.org.au/public-information/fact-sheets-a-z/post-traumatic-stress-disorder.html
3) Stanford researcher, Maurice Ohayon, MD, PhD, conducted a study in Europe of 18,980 people with depression and found them to be five times more likely to suffer from sleep-disordered breathing.  See https://sleepfoundation.org/sleep-disorders-problems/depression-and-sleep
4) VA and Department of Defense article http://www.healthquality.va.gov/guidelines/MH/ptsd/cpgPTSDFULL201011612c.pdf (pg. 63)
All opinions must be supported by a clear rationale.    

 
MARJORIE A. AUER 
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J. Andrew Ahlberg, Counsel