Citation Nr: 20006985 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 16-19 281 DATE: January 28, 2020 ORDER New and material evidence having been received, the claim of service connection for sleep apnea is reopened; to this limited extent, the appeal is granted. REMANDED Service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. Service connection for sleep apnea is remanded.   DECISION The Veteran served on active duty from June 1978 to June 1982, December 1990 to June 1991 and April 2002 to August 2002. The Veteran had additional service in the Air Force Reserve. The case is on appeal from a May 2014 rating decision. The claims came before the Board in September 2018 and were remanded for further development. The psychiatric evidence of record suggests a potential diagnosis of PTSD, as well as diagnoses of depression and anxiety. Therefore, the Board has recharacterized the Veteran’s claim broadly as one for service connection for a psychiatric disorder, to include PTSD. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Whether new and material evidence was received to reopen a previously denied claim of service connection for sleep apnea. By a July 2010 rating decision, a claim of service connection for sleep apnea was denied. The Veteran was notified of the decision by letter later that month, which was mailed to the then current mailing address of record. Thereafter, nothing further regarding the claim was received until the present claim to reopen in December 2012. No new evidence or notice of disagreement was received by VA within one year of the issuance of the July 2010 rating decision. As the Veteran did not appeal the decision, that rating decision is final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. The Board finds that new and material evidence has been submitted so that the previously denied claim of service connection for sleep apnea is reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). See also January 2020 brief in support citing medical literature. The reopened claim is further addressed below. REASONS FOR REMAND Updated VA treatment records should be obtained upon remand. 1. Service connection for a psychiatric disorder, to include PTSD. The Veteran contends that he has PTSD, or another diagnosed psychiatric condition, which is related to service. The Veteran stated in December 2013 that while working on the flight line at Bagram Air Base in Afghanistan during service, he was exposed to sniper fire. He further indicated that during Operation Desert Storm, he was riding to work in a bus which came under fire, killing one of the escorts riding along with the bus. VA has determined that the Veteran’s stressful events occurred during his service. Thus, the question on appeal is which psychiatric diagnoses are established and the etiology of such. As noted, the claim came before the Board in September 2018 and was remanded for further development, including a VA examination to determine whether any diagnosed psychiatric disorder is related to service. The Veteran was afforded a June 2019 VA examination in which the examiner indicated his symptoms do not meet the diagnostic criteria for PTSD under DSM-5 criteria. He determined the Veteran is diagnosed with unspecified sleep-wake disorder. The examiner indicated the Veteran has symptoms of depression, anxiety and chronic sleep impairment. He reported it is less likely than not that the Veteran’s sleep-wake disorder is related to service. He noted there is no documentation in the record that the Veteran was diagnosed with or received treatment for sleep-related issues during service. He indicated the Veteran did not seek help for sleep-related problems until 2013, approximately 8 years after his most recent military stressor occurred. The examiner opined the Veteran’s sleep-related condition is most likely multifactorial and medical factors such as his nonservice-connected sleep apnea cannot be ruled out as contributors. He noted the Veteran’s nightmares cannot be solely attributed to his military experiences and a variety of life stressors and events, not exclusively limited to service, could be involved, such as work/family issues and his perception of underachieving. The examiner further noted bad dreams are not exclusively caused by traumatic events and some of the Veteran’s recurring dreams have no clear link to his in-service stressors. Thereafter, the Veteran’s representative submitted a January 2020 brief which challenged the adequacy of the June 2019 VA examination report. The representative addressed the examiner’s opinion, which described the Veteran’s sleep-related disability as multifactorial, the Veteran’s sleep apnea could be a contributor, and his nightmares cannot be directly or solely attributed to his military experiences. The representative indicated the examiner’s opinion is not specific to the Veteran’s facts, does not consider all the evidence or alternative theories, and is speculative in nature. He contended that a new VA examination is warranted to determine the appropriateness of a diagnosis of PTSD and the etiology of the Veteran’s sleep-related psychiatric disorder. Due to the January 2020 brief in support, along with the other evidence of record, the Board finds an additional VA psychiatric examination is warranted to determine if the Veteran does in fact have PTSD, along with other psychiatric diagnoses, and the etiology of such disorders. 2. Service connection for sleep apnea. The Veteran contends that his sleep apnea was caused or aggravated by his psychiatric disability. The January 2020 representative’s brief supports a link between the Veteran’s psychiatric disability and his diagnosed sleep apnea. He indicated psychiatric disorders and sleep apnea are frequently comorbid, especially with regard to depression and anxiety. He noted medical studies support that psychiatric disorders and their required pharmacological treatment may contribute to and promote the development of sleep apnea. Thus, the outcome with respect to the claim for service connection for a psychiatric disorder may have an impact on the issue of service connection for sleep apnea. As such, the service connection claim for sleep apnea will also be remanded as intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain VA treatment records from August 2019. 2. Thereafter, schedule the Veteran for a VA psychiatric examination by an appropriate medical professional to determine the nature and etiology of any diagnosed psychiatric condition. First, the examiner should identify the Veteran’s current psychiatric disorder(s), including whether he meets the diagnostic criteria for PTSD. If PTSD is diagnosed, the examiner should identify and discuss the related underlying stressor(s). For each psychiatric condition diagnosed, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the diagnosed condition had its onset during, or is otherwise related to, service, to include the Veteran’s established in-service stressors. 3. If service connection is warranted for a psychiatric disability, schedule the Veteran for a VA sleep apnea examination by an appropriate medical professional to determine whether his sleep apnea was caused or aggravated by his service-connected psychiatric disability. The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea was caused or aggravated by his service-connected psychiatric disability, to include the medication required for such. (Continued on the next page)   Aggravation is an increase in severity beyond the natural progress of the disease. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, 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.