Citation Nr: 18157718
Decision Date: 12/14/18	Archive Date: 12/13/18

DOCKET NO. 09-11 550
DATE:	December 14, 2018
REMANDED
Entitlement to sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded.
Entitlement to a rating in excess of 50 percent for PTSD, prior to October 30, 2017, is remanded.
Entitlement to a rating in excess of 70 percent for PTSD, as of October 30, 2017, is remanded.
Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded.
REASONS FOR REMAND
1. Entitlement to sleep apnea, to include as secondary to service-connected PTSD is remanded.
In a June 2018 brief, the Veteran's representative reported that a November 5, 2015, article in the Journal of Clinical Sleep Medicine contained the results of a study indicating that veterans with PTSD screened as high risk for obstructive sleep apnea at much higher rates than those individuals seen in community studies.  In light of that information, an additional VA medical examination should be scheduled to determine the etiology of sleep apnea.  
2. Entitlement to increased ratings for PTSD is remanded.
3. Entitlement to TDIU is remanded.
A May 2012 VA treatment record indicates that there may be outstanding and relevant Social Security Administration (SSA) records.  A remand is required to allow VA to request these records.
The matters are REMANDED for the following action:
1. Obtain the Veteran’s federal records from SSA.  Document all requests for information and all responses in the claims file.
2. Schedule the Veteran for an examination by a medical doctor to determine the nature and etiology of sleep apnea.  The examiner must review the claims file and should note that review in the report.  The examiner must opine whether it is at least as likely as not (50 percent probability or greater) that sleep apnea is related to an in-service injury, event, or disease, including the Veteran's reports of in-service snoring.  The examiner should also opine whether the Veteran's sleep apnea it is at least as likely as not (1) proximately due to service-connected PTSD, or (2) aggravated beyond its natural progression by service-connected PTSD.  In writing the opinion, the examiner should note and remark upon the November 5, 2015, article in the Journal of Clinical Sleep Medicine, referenced by the Veteran's representative in the June 2018 brief.  The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow a substantially gainful occupation due to service-connected disabilities.  If the Veteran is felt capable of work despite the service-connected disabilities, the examiner should state what type of work and what accommodations would be necessary due to the service-connected disabilities.
 
Harvey P. Roberts
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	T.M. Gillett, Counsel