Citation Nr: 20007872 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 19-16 392 DATE: January 30, 2020 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 2012 to April 2014. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In this regard, new and material evidence was associated with the record within the one-year appeal period of that decision, and the Veteran appealed the subsequent rating decision considering this evidence. The Veteran was afforded a VA examination in June 2018, and was diagnosed with mild obstructive sleep apnea. However, no nexus opinion was rendered. In this regard, the Veteran’s service treatment records (STRs) note sleep problems, weight gain, and headaches during active duty. See October 2013, November 2013, January 2014 STRs; see also October 2013 VA Treatment Record; see also January 2014 Medical Evaluation Board Proceedings DA Form 3947; see also January 2014 Dr. E.W. Medical Evaluation Board Notes. Moreover, the record indicates that his service-connected orthopedic disabilities may have caused his weight gain that led to obstructive sleep apnea. Thus, the Board finds that an addendum opinion addressing direct and secondary service connection should be secured on remand, along with any updated treatment records. The issue is REMANDED for the following actions: 1. Obtain updated VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then obtain an addendum opinion addressing the etiology of the Veteran’s obstructive sleep apnea. No additional examination is needed, unless the examiner determines otherwise. The claims file should be made available to and should be reviewed by the examiner. The examiner is requested to respond to the following: (a) Please opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s obstructive sleep apnea had its onset during, or is otherwise etiologically related, to the Veteran’s active duty service? In addressing this question, please consider STRs noting sleep problems, weight gain, and headaches. See October 2013, November 2013, January 2014 STRs; see also October 2013 VA Treatment Record; see also January 2014 Medical Evaluation Board Proceedings DA Form 3947; see also January 2014 Dr. E.W. Medical Evaluation Board Notes. (b) (1) If the answer to question (a) is no, is it at least as likely as not (50 percent or greater probability) the Veteran’s service-connected knee and back disabilities caused him to become obese? In addressing this question, please consider the Veteran’s STRS evincing a 24-pound weight gain (from 189 to 213 pounds) from April to November 2013. (2) If so, is it at least as likely as not that obesity was a “substantial factor” in causing his obstructive sleep apnea? (3) If so, is it at least as likely as not that obstructive sleep apnea would not have occurred but for obesity caused by the service-connected knee and back disabilities? Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Ramirez, 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.