Citation Nr: 18160973 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 17-13 938 DATE: December 28, 2018 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1989 to September 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Board notes that a November 2015 rating decision previously denied service connection for sleep apnea. However, within one year of the rating decision, new and material evidence was associated with the claims file, which consisted of a lay statement from the Veteran’s spouse. As such, the November 2015 rating decision did not become final. See 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2010). The Veteran was diagnosed with moderate to severe obstructive sleep apnea following a polysomnogram in July 2015. He submitted a claim for service connection for sleep apnea due to an undiagnosed illness in August 2015, and he was afforded a VA examination in September 2015. The VA examiner stated that sleep apnea is a disease with a clear and specific etiology and diagnosis and noted that there is no causal relationship in the medical literature between sleep apnea and exposure events experienced by servicemembers in Southwest Asia. Therefore, the examiner opined that the Veteran’s sleep apnea is less likely than not related to service in southwest Asia. Subsequently, the Veteran clarified that, although he had claimed sleep apnea as due to an undiagnosed illness, he was instead claiming that he had symptoms in service that have continued since that time. See December 2015 lay statement attached to January 2016 claim for reconsideration. The Veteran has indicated that he originally thought that he had chronic fatigue syndrome, but that the disorder was actually undiagnosed sleep apnea. See May 2016 Notice of Disagreement (NOD). He has reported that he had symptoms of sleep apnea in service, including loud snoring and interrupted breathing, and reported them to flight surgeons, but he was not treated because it would affect his flight status. See May 2016 NOD; March 2017 VA Form 9. He also submitted a May 2016 lay statement from his spouse, F.N. (initials used to protect privacy), who indicated that she routinely witnessed the Veteran snore loudly and stop breathing for a short time while sleeping from 1991 to the present. As previously noted, the September 2015 VA examiner opined that the Veteran’s sleep apnea was not caused by or the result of service in Southwest Asia; however, he did not provide an opinion as to whether the Veteran’s sleep apnea was otherwise directly related to his military service, to include any symptomatology therein. Thus, in light of the lay statements, the Board finds that an additional medical opinion is needed. The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers not already of record who have provided treatment for sleep apnea. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. Any outstanding VA medical records should also be obtained and associated with the claims file, including records from the Oklahoma City VAMC. 2. After the above development has been completed, the Veteran should be afforded a VA examination to determine the nature and etiology of any sleep apnea that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should state whether it is at least as likely as not that the Veteran has sleep apnea that manifested in or is otherwise causally or etiologically related to his military service, including any reported symptomatology therein. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available for review. 3. The AOJ should conduct any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.S. Chilcote, Associate Counsel