Citation Nr: 18157453 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 16-58 382 DATE: December 12, 2018 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND 1. Entitlement to service connection for sleep apnea is remanded. The Veteran served honorably on active duty in the United States Navy from September 1964 through October 1967. For his meritorious service, the Veteran was awarded (among other decorations) the Vietnam Campaign Medal and the Vietnam Service Medal. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran contends he is entitled to service connection for sleep apnea. The Veteran states he believes he should be service connected for sleep apnea either on a direct basis or as secondary to his service-connected PTSD. In support of his claim, the Veteran submitted medical literature noting an association between psychiatric disorders and sleep apnea. In August 2016, the Veteran underwent a VA examination for sleep apnea. The examiner reported that sleep apnea is not related to or caused by PTSD and there is no preponderance of the evidence to link the two conditions in expert literature. After the Statement of Case was provided, the Veteran submitted his own statement regarding his condition and a lay statement from his former spouse. The Veteran feels that the in-service experiences contributed to his PTSD, for which he is service connected, and that the nightmares he suffers cause his sleep deficit. In December 2016 an addendum opinion was drafted by the same examiner who performed the initial VA examination. The examiner reported that sleep symptoms in service do not define sleep apnea and that a sleep study is needed to diagnose the etiology of sleep symptoms. The examiner reported that sleep apnea is not due to or caused by PTSD and again concluded there is no preponderance of the evidence to support this contention. Both the April 2016 examination and December 2016 addendum are insufficient. The examiner opined that there is no preponderance of the evidence to support the Veteran’s contentions. This is the incorrect standard of proof for VA. VA’s standard of proof for service connection is “at least as likely than not,” not “preponderance of the evidence.” As the examiner relied on an incorrect standard of proof, both the April 2016 examination and December 2016 addendum are insufficient for determining service connection. Given the deficiencies in the VA opinions of record, the case is remanded for another medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311(2007). Accordingly, upon remand, the most recent VA treatment records should be obtained. Also referenced in VA treatment records is the notation of private treatment records with the initial diagnosis of sleep apnea. Therefore, with Veteran’s assistance, it is necessary to obtain any private medical records regarding the sleep study the Veteran underwent. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from November 2016 to the present. 2. With any necessary assistance from the Veteran, obtain any private treatment records regarding his diagnosis of and treatment for sleep apnea. 3. Obtain an opinion regarding the possible relationship of the Veteran’s sleep apnea to his active service or to his service-connected PTSD from an appropriate examiner, but not from the examiner who conducted the April 2016 examination. If the examiner determines that the below requested opinions cannot be offered without first examining the Veteran, then schedule the Veteran for an appropriate examination. Regardless of whether an examination is performed, the examiner is to answer the following questions: a. Is it at least as likely as not that the Veteran’s current sleep apnea had it onset during or is otherwise related to his active service? In answering this question, the examiner must address and discuss the lay statements of record regarding the Veteran’s history of sleep problems. b. Is it at least as likely as not that the Veteran’s current sleep apnea is proximately due to, the result of, or aggravated by the Veteran’s service-connected PTSD? In answering this question, the examiner must address the literature submitted by the Veteran regarding an association between psychiatric disorders and sleep apnea. A complete rationale for all opinions offered must be provided. 4. After the requested opinion has been obtained, the AOJ must ensure that the questions asked by the Board have been answered and, if not, conduct any further development as required. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Mouzakis, Associate Counsel