Citation Nr: 20007564 Decision Date: 01/30/20 Archive Date: 01/29/20 DOCKET NO. 16-63 995 DATE: January 30, 2020 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1981 to June 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) during a December 2019 videoconference hearing. A transcript of that hearing is associated with the claims file. Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder, is remanded. The Veteran contends that she suffers from sleep apnea related to her period of active service, or alternatively, as secondary to her service-connected posttraumatic stress disorder (PTSD). The Veteran submitted a private opinion from Dr. N.D. dated in February 2016 indicating that sleep apnea is more likely than not a result of her PTSD. Although Dr. N.D. noted the Veteran’s reported symptomatology and stated that he has known the Veteran for about 15 years, he did not provide a rationale for his opinion. The Veteran was afforded a VA sleep apnea examination in April 2016. The examiner stated that the Veteran was diagnosed with obstructive sleep apnea in 2011. After reviewing the treatment records and examining the Veteran, the examiner opined that the Veteran’s sleep apnea was less likely than not related to her service-connected PTSD. The rationale was that although PTSD can affect sleep and there are many associations between PTSD and sleep apnea, there is no medical literature to support an etiological link between PTSD and sleep apnea. The examiner did not address the February 2016 private opinion or the Veteran’s contention that her PTSD, and medication prescribed therefor, aggravates her sleep apnea. During the December 2019 Board hearing, the Veteran testified that she was diagnosed with both obstructive sleep apnea and central sleep apnea. She stated that her central sleep apnea was aggravated by the medication she was prescribed for PTSD that depresses her central nervous system. She further indicated that her sleep apnea is related to her PTSD because she gained weight related to stress-eating. The Board finds that the VA examiner’s opinion is inadequate to adjudicate the claim. Specifically, the opinion fails to address the Veteran’s contentions regarding her weight gain or prescribed medication. Additionally, an opinion must be obtained regarding any aggravation of her sleep apnea by her PTSD. See El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013). Accordingly, an addendum opinion should be obtained. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The matter is REMANDED for the following action: 1. After obtaining any necessary releases, obtain any outstanding VA or private treatment records pertinent to the Veteran’s claim. 2. Thereafter, obtain an addendum opinion from an appropriate examiner regarding the nature and etiology of the Veteran’s sleep apnea. The claims file should be available to, and reviewed by, the examiner. If the examiner feels an additional examination is necessary, one should be arranged. All necessary tests and studies should be completed. The examiner should address the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea is proximately due to her service-connected PTSD? The examiner should address the Veteran’s claimed weight-gain related to her PTSD. (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea was aggravated by her service-connected PTSD? The examiner should address the Veteran’s contentions that medication prescribed for her PTSD aggravates her sleep apnea. The examiner must provide a rationale for all requested opinions. CAROLINE B. FLEMING Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Connor, 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.