Citation Nr: 20002242 Decision Date: 01/10/20 Archive Date: 01/09/20 DOCKET NO. 18-44 061 DATE: January 10, 2020 REMANDED Entitlement to service connection for obstructive sleep apnea, including as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran had active service from February 1968 to November 1969. He also served in the Navy Reserves from October 1967 to February 1968 and November 1969 to October 1973. Other service treatment records indicate additional periods of reserve service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Although the issue on appeal was characterized as whether to reopen a previously denied claim, the Board notes that service department records appear to have been associated with the claims file since the last final decision in 2015. Therefore, the issue has been recharacterized as a de novo review. The Board notes that the Veteran has seen a private physician for his treatment of sleep apnea at Family Health Associates. Additionally, the Board acknowledges the possibility and probability that he has continued treatment with the VA since his latest medical records regarding this matter in May 2018. Therefore, the Board requests that the Veteran’s treatment records from Family Health Associates and updated VA treatment records be obtained and associated with the claims file. The Board also notes that there is a medical opinion of record in the form of a September 2015 VA examination which concludes that the Veteran’s obstructive sleep apnea is less likely than not related to his service-connected PTSD. The examiner’s rationale was that the obstructive sleep apnea was less likely than not caused by service-connected PTSD because “[t]here is no generally accepted connection between the two conditions.” The examiner also stated that it is less likely than not that the Veteran’s service-connected PTSD aggravated his obstructive sleep apnea, reasoning that “[i]t would require speculation on the severity of his PTSD and its effect on his sleep.” Although a private physician opined that the Veteran’s obstructive sleep apnea “is either directly, more likely than not, or at least aggravated by his service-connected Post Traumatic Stress Disorder,” he did not provide a rationale as to his finding. See January 2018 Letter from Family Health Associates, LLC. The Board acknowledges that there is another VA opinion of record from March 2018, opining that the Veteran’s obstructive sleep apnea is less likely than not caused by his service-connected PTSD. However, this opinion did not address whether it was at least as likely as not that the Veteran’s obstructive sleep apnea was aggravated by his service-connected PTSD. In light of the incomplete opinions of records, the Board finds that a new medical examination is warranted. The matters are REMANDED for the following action: 1. The RO should provide the Veteran notice as to the elements of service connection, the types of evidence that could support the claim, and the allocation of responsibilities between the Veteran and VA for obtaining relevant records and other evidence on his behalf in accordance with VCAA. 2. Request the Veteran to identify any recent outstanding VA and/or private treatment records as relate to his obstructive sleep apnea, including from Family Health Associates, LLC. Appropriate efforts must be made to obtain these records if he has adequately identified them and authorized their release (with respect to any private treatment records). He should also be invited to submit these records himself. All actions to obtain the requested records should be fully documented in the claims file. If they cannot be located or no such records exist, the Veteran and his representative should be so notified in writing. 3. After completing the foregoing development, schedule the Veteran for an appropriate examination to determine the nature and etiology of his obstructive sleep apnea. The entire claims file, including a copy of this remand, must be made available to the examiner, who must note its review. The examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s obstructive sleep apnea manifested during, or is the result of, his active service or ACDUTRA. The examiner is also asked to provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s obstructive sleep apnea was either (i) caused or (ii) aggravated by his service-connected PTSD. The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Seserman The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.