Citation Nr: 18160091
Decision Date: 12/21/18	Archive Date: 12/21/18

DOCKET NO. 16-56 730
DATE:	December 21, 2018
REMANDED
Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded.
REASONS FOR REMAND
The Veteran served on active duty from January 2000 to January 2003, February 2003 to June 2004, July 2008 to September 2009, and August 2011 to October 2012. He also had additional service in the Army National Guard.  
This matter comes before the Board of Veterans’ Appeals (Board) from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. 
Entitlement to service connection for sleep apnea to include as secondary to service-connected PTSD is remanded.
The Veteran seeks entitlement to service connection for sleep apnea, to include as secondary to service-connected PTSD. The Veteran reported that his doctor told him that his PTSD could cause his sleep apnea. See August 2015 Notice of Disagreement.  
Service treatment records reflect that on an August 2012 Post-Deployment health assessment, the Veteran reported problems sleeping or still feeling tired after sleeping. A February 2010 private report of polysomnography shows that the Veteran was diagnosed with upper airway resistance syndrome (PLMS). A September 2012 Hi Desert Cardio Pulmonary Medical Group, Inc, follow-up note shows that the Veteran was diagnosed with PLMS two years ago and that he was told to come back for the results. Dr. R. Y. indicated that the Veteran did not use his CPAP machine as he was deployed to a war zone in Afghanistan. 
The Veteran underwent a VA General Medical examination in June 2014. The June 2014 VA examination and opinion for sleep apnea is inadequate and the claim is remanded for a new examination. The examiner’s rationale is inadequate because it only states “that the Veteran was diagnosed with obstructive sleep apnea (OSA) in between his 2nd and 3rd active duty periods. Veteran’s increase in weight as documented most likely played a significant role in acquiring OSA.” The opinion does not discuss the Veteran’s diagnosis of sleep apnea in 2010 in between his periods of active duty service. The examiner also did not address whether the Veteran’s sleep apnea was aggravated (permanently worsened beyond the natural progression of the disorder) by the Veteran’s service-connected PTSD. 
As such, a remand is necessary to obtain an opinion on the etiology of his sleep apnea. 
The matter is REMANDED for the following action:
Forward the record to a VA clinician with appropriate expertise for preparation of an addendum opinion. The examiner is asked to provide a thorough response to each of the following:
(a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea disorder is proximately due to or the result of any of the Veteran’s service-connected disabilities, to include PTSD?
(b) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea disorder has been aggravated by any of the Veteran’s service-connected disabilities, to include PTSD?
Aggravation is defined as a worsening beyond the natural progression of the disease. The examiner must note that an opinion to the effect that one disability “is not caused by or a result of” another disability does not answer the question of aggravation and will necessitate a further opinion. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013).
The examiner should consider and discuss the August 2012 Post-Deployment health assessment and February 2010 private report of polysomnography.
The examiner should indicate that the record was reviewed. A complete rationale should be provided for all opinions given. 
 
BARBARA B. COPELAND
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	T. Grzeczkowicz, Associate Counsel