Citation Nr: 20007579 Decision Date: 01/29/20 Archive Date: 01/29/20 DOCKET NO. 19-06 087A DATE: January 29, 2020 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to the Veteran's service-connected posttraumatic stress disorder (PTSD) and/or coronary artery disease (CAD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1968 until his honorable discharge in January 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision by the Lincoln, Nebraska Regional Office (RO) of the United States Department of Veterans Affairs (VA). 1. Entitlement to service connection for obstructive sleep apnea, to include as secondary to the Veteran's service-connected PTSD and/or CAD is remanded. In November 2017, the Veteran submitted an Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ). Within his application, he applied for entitlement to service connection for obstructive sleep apnea under two theories of entitlement. His first theory was that his obstructive sleep apnea was secondary to his PTSD and/or CAD. His second theory was that obstructive sleep apnea was directly incurred in service. In January 2019, the Veteran was afforded a VA examination for his obstructive sleep apnea. The January 2019 VA examiner rendered an opinion addressing secondary service connection and aggravation, but did not offer an opinion on direct service connection. In March 2019, the RO obtained an addendum opinion on secondary service connection and aggravation, but still did not obtain an opinion on direct service connection. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). In the present case, the VA examiners did not address the Veteran’s claim for entitlement to direct service connection for obstructive sleep apnea. As it pertains to the opinion addressing the theory of secondary service connection, an adequate examination must include a detailed rationale for the opinion provided. If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010). (The AOJ should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained). The Board cannot make a fully-informed decision on the issue of entitlement to service connection for obstructive sleep apnea, to include as secondary to the Veteran’s service-connected PTSD and/or CAD because no VA examiner has opined whether direct service connection may be warranted and no VA examiner has properly addressed if the Veteran’s obstructive sleep apnea was aggravated by his service-connected PTSD and/or his CAD. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran’s obstructive sleep apnea from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. A detailed explanation for all opinions expressed must be provided. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the obstructive sleep apnea had onset in, or is otherwise related to, active service, including but not limited to secondary to the Veteran’s service-connected PTSD and/or his service-connected CAD. The examiner must specifically address the following: (a) The Veteran’s claim for entitlement to service connection on a direct basis; (Continued on the next page)   (b) If the Veteran’s obstructive sleep apnea has been aggravated by his PTSD and/or CAD and if aggravation of the Veteran’s obstructive sleep apnea cannot be determined, the examiner’s opinion must include the reason(s) that aggravation could not be determined, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Deemer 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.