Citation Nr: 20002886 Decision Date: 01/14/20 Archive Date: 01/13/20 DOCKET NO. 15-06 264A DATE: January 14, 2020 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected asbestosis with pleural plaques and interstitial and restrictive lung disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from November 1962 to November 1966. This matter initially came before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The undersigned held a videoconference hearing with the Veteran in September 2016. A transcript of the hearing is in the file. The Board remanded the case in June 2018 for a VA examination. Thereafter, a May 2019 supplemental statement of the case denied service connection for a lack of nexus. The Veteran then submitted additional evidence to the RO. Another supplemental statement of the case was issued in June 2019, which also denied service connection for sleep apnea for a lack of nexus. An additional supplemental statement of the case was issued in September 2019, which again denied service connection for sleep apnea for a lack of nexus. Entitlement to service connection for sleep apnea, to include as secondary to service-connected asbestosis with pleural plaques and interstitial and restrictive lung disease is remanded. Pursuant to the Board’s June 2018 Remand, the Veteran was given a VA examination for his sleep apnea in April 2019. Here, the examiner diagnosed the Veteran with sleep apnea and opined that his condition is less likely than not caused or aggravated by his service-connected asbestosis. The examiner explained that “there is no pathophysiologic connection between asbestosis and sleep apnea” due to the way asbestosis affects the airways and how sleep apnea occurs, and therefore, there is no “likelihood for causation or aggravation.” Thereafter, in connection with the Veteran’s asbestosis claim, a June/July 2019 VA examination report was associated with the file. In Section II Medical History, the examiner noted, in relevant part, that the Veteran “has sleep apnea associated with the asbestosis, requiring CPAP therapy at night.” In Section III, Part L, in response to the question of whether the Veteran had any other pertinent physical findings, complications, conditions, signs or symptoms related to the asbestosis diagnosis, the examiner noted as follows: “Asbestos Exposure secondary pulmonary hypertension with right atrial enlargement, chronic atrial fibrillation, sleep apnea requiring CPAP Asbestosis.” The Board finds that a clarifying opinion is needed to reconcile the above findings. The matter is REMANDED for the following action: 1. Contact the Veteran and request that he identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who treated him from discharge until the present for sleep apnea. With any necessary authorization from the Veteran, the AMO should attempt to obtain copies of treatment records identified by the Veteran which have not previously been obtained. Failures to respond or negative replies should be noted and associated with the file. 2. Obtain updated VA treatment records dated from May 2016 to the present. 3. Obtain an addendum opinion from a sleep specialist to address whether the Veteran has sleep apnea due to service or secondary to service-connected disability. In light of the April 2019 VA opinion and June/July 2019 VA opinion with particular attention drawn to Section II Medical History and Section III, Part L, the examiner is asked to provide a clarifying opinion and answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea began in (or is related to) his active service? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea was caused by his service-connected asbestosis with pleural plaques and interstitial and restrictive lung disease? (c.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s sleep apnea was aggravated beyond its natural progression by his service-connected asbestosis with pleural plaques and interstitial and restrictive lung disease? A detailed rationale for the opinion must be provided. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Papacalos, Law Clerk 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.