Citation Nr: 20003586 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 13-30 294 DATE: January 15, 2020 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from June 1976 to July 1979. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2018, the Board denied the claim. The Veteran appealed the denial to the U.S. Court of Appeals for Veterans Claims (Court). By way of a July 2019 Order, the Clerk of the Court issued a Joint Motion for Remand (JMR). In August 2019, the Veteran was sent notice of the JMR and provided an additional 90 days to submit evidence or argument. An additional appellate brief was filed in November 2019. 1. Entitlement to service connection for sleep apnea is remanded. The Court has determined that the January 2018 VHA opinion is inadequate to decide the claim because its rationale is unclear. This finding applies to both the opinion on direct service connection and the opinion on secondary service connection. Accordingly, on remand, a new medical opinion should be obtained. The matters are REMANDED for the following action: Obtain a supplemental medical opinion concerning the etiology of the Veteran’s obstructive sleep apnea. The examiner must review the claims file in conjunction with authoring the opinion. The examiner is asked to provide responses to the following: A) The Veteran reported experiencing disturbed sleep and tiredness during the day while on active duty. If accepted as true, would his report of such symptoms make it at least as likely as not (a 50 percent or greater probability) that the subsequently diagnosed obstructive sleep apnea was present in service? The Board recognizes that the Veteran’s service records did not show treatment, complaints, or a diagnosis of a sleep disorder. The Veteran asserts that he thought his symptomology was normal at the time and did not seek help for it. The examiner should consider the June 2016 VA examination opinion and the January 2018 VHA opinion in formulating the requested opinion. The examiner should take into consideration the January 2018 VHA examiner’s statements that 1) sleep apnea is a common and likely under reported diagnosis in the military community; and 2) that it is possible, due to training and service requirements, that the Veteran may have had a sleep disorder diagnosis during his time in the service. B) Is it at least as likely as not the Veteran’s obstructive sleep apnea was proximately caused or aggravated by his service-connected posttraumatic stress disorder (PTSD)? The examiner should consider the medical study cited by the Veteran’s representative, found at http://dx.doi.org/10.5664/jcsm.4692. The examiner should also consider the January 2018 VHA examiner’s statements that 1) there is an association between PTSD and sleep apnea; 2) it is possible and likely that sleep apnea symptoms may worsen PTSD and vice versa; and 3) the relative contribution of the worsening of the Veteran’s sleep apnea by his PTSD symptoms is difficult to qualify or quantify. A fully-explained rationale must be provided for all opinions expressed. If the examiner relies on relevant medical literature/scientific studies in reaching his or her opinion, the rationale should identify and discuss such. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mike A. Sobiecki, Associate Counsel 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.