Citation Nr: 20004579 Decision Date: 01/23/20 Archive Date: 01/21/20 DOCKET NO. 19-14 420 DATE: January 23, 2020 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active duty service from June 1964 to September 1967. This case is before the Board of Veterans’ Appeals (Board) on appeal from a December 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for sleep apnea is remanded. The Veteran is seeking service connection for his sleep apnea, to include as secondary to his service-connected posttraumatic stress disorder (PTSD). Specifically, the Veteran contends that his sleep apnea is exacerbated by his PTSD, or alternatively, that his PTSD has caused the Veteran to have chronic sleep problems which have been diagnosed as sleep apnea. The Board concludes that an addendum to the July 2019 VA examination is necessary before a decision can be reached on this matter. On VA examination in July 2019, the examiner noted that the Veteran underwent a sleep study in 2009 which resulted in a diagnosis of obstructive sleep apnea. The examiner noted that the Veteran required the use of a continuous positive airway pressure (CPAP) machine. The examiner found that the Veteran's sleep apnea was less likely than not proximately due to or the result of the Veteran's service-connected PTSD. The examiner’s provided a general explanation as to sleep apnea’s symptoms, the likely causes (mainly obesity and other anatomical features), and other contributing factors. Then, the examiner concluded that the Veteran’s sleep apnea is cause by physical symptoms, not PTSD. The Board finds this opinion to be inadequate because although the examiner found that the Veteran's sleep apnea was not related to the Veteran's service-connected PTSD, the examiner did not specifically address whether the Veteran's sleep apnea could have been aggravated by his service-connected PTSD. The examiner also did not address whether the PTSD caused or contributed to his obesity, which, in turn, caused or contributed to his sleep apnea. In light of the foregoing, the RO should obtain an addendum opinion, with an adequate rationale, addressing whether the Veteran's sleep apnea has been aggravated by his service-connected PTSD, and/or his PTSD caused or contributed to his obesity, which, in turn, caused or contributed to his sleep apnea. In this regard, it should be noted that obesity itself cannot be service connected, but it can be used as a “stepping stone” between a service-connected disability and a nonservice-connected disability. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's sleep apnea at least as likely as not (50 percent probability or greater) had its onset during his active service or is otherwise related to his active service. In providing this opinion, the examiner must consider the Veteran's assertions that he was told by a roommate during his active service that he snored loudly and for the purpose of this opinion, accept those assertions as true. If not, the clinician must provide an opinion as to whether it is at least as likely as not that the Veteran's sleep apnea is proximately due to or caused by his service-connected PTSD. If not, the clinician must provide an opinion as to whether it is at least as likely as not that the Veteran's sleep apnea is aggravated beyond its natural progression by is his service-connected PTSD. Finally, the clinician should provide an opinion as to whether the Veteran’s PTSD caused on contributed to his obesity, which then caused or contributed to his sleep apnea. A complete rationale for all opinions rendered must be provided. If the examiner cannot provide an opinion without resorting to speculation, he or she should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. R. Montalvo, 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.