Citation Nr: 18157632
Decision Date: 12/13/18	Archive Date: 12/12/18

DOCKET NO. 16-63 110
DATE:	December 13, 2018
REMANDED
Entitlement to service connection for sleep apnea is remanded.
REASONS FOR REMAND
The Veteran had active service from May 1988 to October 2011.
This case comes before the Board of Veterans’ Appeals (Board) on appeal of a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. The claim had previously been denied in a July 2014 rating decision; however, as the new claim was received in March 2015, within one year, the Board does not consider that earlier decision to be a final decision per 38 U.S.C. § 7105.
The Board has reviewed the evidence presently in the record and observes that there are VA treatment records and private provider medical records indicating that the Veteran has sleep apnea. For instance, a February 2013 post deployment intake assessment notes that the Veteran “[has] not yet received sleep apnea equipment; only recently [diagnosed].” Private treatment records from December 2012 reveal the Veteran underwent a sleep study that resulted in a diagnosis of positional obstructive sleep apnea. Additionally, an April 2014 sleep apnea disability benefits questionnaire (DBQ) notes in the medical history that “[t]hese disorders began immediately after returning from a six-month deployment to South West Asia in December 1992.”  However, the examiner did not provide an opinion regarding etiology of the disability. The Veteran also asserted in a December 2016 Form 9 that he sought treatment for sleep apnea symptoms while stationed outside the country during active service. A VA examination is necessary in this instance to clarify whether the Veteran has a sleep apnea diagnosis which is etiologically related to service.
The matter is REMANDED for the following action:
1. Furnish the Veteran a 38 C.F.R. § 3.159(b) letter addressing the Veteran’s claim under 38 C.F.R. § 3.310 (secondary service connection).
2. Afford the Veteran a VA medical examination to ascertain the current severity and etiology of the Veteran’s sleep apnea. The claims file must be reviewed by the examiner. The examiner is asked to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s sleep apnea had onset during or was caused by his active service, or, in the alternative, whether it is at least as likely as not (50 percent or greater probability) that his sleep apnea was caused or aggravated (worsened beyond natural progression) by any service-connected disabilities (as listed in a February 2016 rating decision). If aggravation is found, the examiner should specify the baseline level of severity of the sleep apnea before the chronic worsening and the level of severity of the sleep apnea after the chronic worsening. 
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All opinions and conclusions must be supported by a rationale.
 
A. C. MACKENZIE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Banks, Associate Counsel