Citation Nr: 18160052
Decision Date: 12/21/18	Archive Date: 12/20/18

DOCKET NO. 17-07 878
DATE:	December 21, 2018
REMANDED
Entitlement to service connection for sleep apnea is remanded.
REASONS FOR REMAND
The Veteran served on active duty from July 1988 to August 1998.
1. Entitlement to service connection for sleep apnea is remanded.
The Veteran underwent VA examination in November 2013.  The VA examiner opined that it is less likely as not that the Veteran’s sleep apnea had an onset in service or is otherwise related to service.  The VA examiner explained that the Veteran’s service treatment records were silent for sleep-related complaints and that the Veteran’s post-service treatment records did not show a chronic sleep disorder until 2009.  However, the Veteran’s service treatment records show complaints of sleeping problems, severe snoring, swollen glands in the morning, and sleepiness during the day.  A March 1998 service treatment record states that obstructive sleep apnea should be ruled out and that a sleep study should be scheduled.  The November 2013 VA medical opinion is therefore based on an inaccurate factual premise.  See Reonal v. Brown, 5 Vet. App. 458, 461(1993).  Moreover, the VA examiner did not address the Veteran’s reports that his snoring and gasping for air started years earlier and gradually worsened until he sought treatment in 1998.  See, e.g., December 2012 Claim.  In addition, during the November 2013 VA examination, the Veteran suggested a potential link between his sleep problems and his service-connected joint disabilities.  Accordingly, remand is appropriate for further VA medical opinion.
While this matter is on remand, any additional outstanding treatment records should be obtained.
The matter is REMANDED for the following action:
1. After securing any necessary authorization, obtain any additional private treatment records as the Veteran may identify relevant to his claim.
2. After obtaining any outstanding records, ask the appropriate examiner to review the Veteran’s file.  The necessity of an in-person examination, with any appropriate testing, is left to the discretion of the examiner.  
The examiner should identify any sleep disorder exhibited by the Veteran since December 2012 and opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s sleep apnea (or other identified sleep diagnoses: (a) had an onset in service; (b) is otherwise related to an in-service injury, event, or disease; or (c) is caused by or aggravated by any of his service-connected disabilities (his hip, spine, and radiculopathy disabilities).
The examiner should consider all medical and lay evidence of record.
The Veteran’s service treatment records show complaints of sleeping problems, severe snoring, swollen glands in the morning, and sleepiness during the day.  A March 1998 service treatment record states that obstructive sleep apnea should be ruled out and that a sleep study should be scheduled.
The Veteran reported that his snoring started during the late 1980s or around 1990 or 1991 and gradually worsened until he sought treatment in 1998.  He reported that he finally sought treatment as his condition was becoming unbearable for him and for his wife.  The Veteran also explained that his demanding schedule and location within Germany prevented him from obtaining proper treatment for sleep apnea during service or immediately after service.  
During the November 2013 VA examination, the Veteran also suggested a potential link between his sleep problems and his service-connected joint disabilities.  
If the Veteran’s reports are discounted, the examiner should provide a rationale for doing so (e.g., whether there is any medical reason to accept or reject his contentions).
A complete rationale should be given for all opinions and conclusions expressed.
 
 MARJORIE A. AUER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. Purcell, Associate Counsel