Citation Nr: 20007465 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 12-14 053 DATE: January 29, 2020 REMANDED Service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from January 1987 to April 1991 and July 1993 to April 2009, including foreign service. For his meritorious service, the Veteran was awarded (among other decorations) the Overseas Service Medal, Navy and Marine Corps Achievement Medal, Armed Forces Expeditionary Medal, and the Sea Service Deployment Ribbon. This appeal was previously remanded by the Board in June 2017 for additional development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Although the Board sincerely regrets the additional delay this will cause, further development is necessary prior to the adjudication of this appeal. Notably, the June 2017 remand instructed that an adequate VA nexus opinion be obtained. Although a Disability Benefits Questionnaire (DBQ) was provided in October 2019, the physician addressed only whether there was a direct link between the Veteran’s service and sleep apnea. However, the record contains competent evidence of a possible secondary link between the Veteran’s claimed sleep apnea and his service-connected hypertension. See, e.g., October 2019 DBQ (noting that the Veteran’s hypertension is “independent” from his sleep apnea); July 2013 VA memorandum (associating Veteran’s sleep apnea with his hypertension); March 2010 sleep study (noting that the Veteran’s medical history is pertinent for hypertension). In providing a negative opinion, the examiner noted that the incidence of sleep apnea increases in men due to age, BMI, and neck circumference. Considering that the Veteran retired from active service in April 2009 and was diagnosed with sleep apnea in January 2010, the Board questions whether those nine months featured all of the changes and risk factors cited by the examiner, and why such changes would not have been present in 2009 during the Veteran’s active service. Given the Veteran’s foreign address, an addendum opinion rather than an examination will be requested upon remand. The matter is REMANDED for the following action: Obtain a VA addendum opinion regarding the Veteran’s sleep apnea claim. The claims file and a copy of this remand must be made available for review. In particular, the examiner must state: (1) Whether it is at least as likely as not that the Veteran’s sleep apnea had its onset during or is otherwise related to his active service. In answering this question, the examiner is advised that the Board finds the Veteran’s and his wife’s reports of symptoms in-service (to include snoring and breathing cessation) to be credible. (2) Whether it is at least as likely as not that the Veteran’s sleep apnea is proximately due to, the result of, or aggravated by his service-connected hypertension or the treatment thereof. In doing so, the examiner must address the relevant evidence of record, including a March 2010 sleep study, July 2013 VA memorandum, and October 2019 DBQ. The examiner must also state whether the Veteran’s in-service hypertension was evidence that the Veteran’s sleep apnea existed during his active service. A complete rationale should be provided for all opinions or conclusions expressed. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kovarovic, 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.