Citation Nr: 18161249 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 17-09 169 DATE: December 31, 2018 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected peptic ulcer disease and gastroesophageal reflux disease (GERD) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1986 to August 2006. Upon review of the record, the Board finds that the issue must be remanded. The Board sincerely regrets the additional delay caused by this remand, but wishes to assure the Veteran that it is necessary for a full and fair adjudication of the claim. 1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected peptic ulcer disease and GERD is remanded. The Board finds that a new VA examination and opinion is warranted for the Veteran’s sleep apnea claim. In December 2013 the Veteran underwent a VA examination for his sleep apnea. The examiner did not provide an opinion as to the etiology of the Veteran’s sleep apnea other than summarily concluding it was unrelated to the Veteran’s service-connected peptic ulcer disease and GERD. As the etiology opinion of the Veteran’s sleep apnea is necessary to make a decision on the Veteran’s claim, and the examination provided is inadequate, remand is required to obtain this opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate). The matter is REMANDED for the following action: 1. Assist the Veteran in associating with the claims folder updated treatment records. 2. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to determine the nature and etiology of the Veteran’s sleep apnea. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and conducting an examination of the Veteran, the examiner should respond to the following: a) The examiner should state whether it is at least as likely as not (a 50 percent probability or more) that the sleep apnea began in service, was caused by active service, or is otherwise related to active service. The examiner should take a thorough history from the Veteran regarding the onset and pattern of his symptoms. b) The examiner should state whether it is at least as likely as not (50 percent or greater probability) that the sleep apnea was caused or aggravated by the Veteran’s service-connected peptic ulcer disease and GERD. • If the examiner finds that the Veteran’s sleep apnea was aggravated by his service-connected peptic ulcer disease and GERD, then he/she should specify the baseline level of disability of the disability prior to aggravation and the permanent, measurable level of increased impairment due to service-connected peptic ulcer disease and GERD. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinions. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Gandhi, Associate Counsel