Citation Nr: 20074841 Decision Date: 11/23/20 Archive Date: 11/23/20 DOCKET NO. 15-31 137 DATE: November 23, 2020 REMANDED Service connection for a sleep disorder, to include sleep apnea, insomnia, and delayed sleep phase syndrome, is remanded. REASONS FOR REMAND The Veteran had active service from August 1972 to March 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Decatur, Georgia. In October 2018, the Veteran testified before the undersigned at a videoconference hearing. A transcript of the hearing is associated with the claims file. In May 2019, the Board remanded the claim for additional development. Given the Veteran’s various sleep diagnoses as noted in his medical records, the Board has expanded the scope of the Veteran’s appeal to include consideration as to whether service connection may be awarded for any current sleep disorder. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). The Board finds that the claim must be remanded for a new medical opinion. In this regard, in addition to his diagnosis of obstructive sleep apnea, VA medical records show that the Veteran has been assessed with delayed sleep phase syndrome (DSPS), See February 2012 VA sleep medicine progress note, and a February 2020 examiner suggested the Veteran may have insomnia. The Veteran’s service treatment records show that in January 1973, the Veteran presented for an evaluation of somnolence that had been noted by ship officers to the point where a medical evaluation was recommended. The Veteran explained that it had been present ever since he had sustained blunt trauma to his cervical spine while driving. Upon evaluation, it was noted that the Veteran would go to bed around 3:00 or 4:00 in the morning and have to wake up at 5:30 in the morning for work. Another treatment note from January 1973 reflects the Veteran’s statements that he had a difficult time staying awake and could fall asleep anywhere at any time. The Veteran also submitted a one-page document that appears to be a part of his administrative discharge papers, which shows that the Veteran was given a general discharge under honorable conditions due to poor performance, which was based on the fact that the Veteran was often found to be sleeping rather than performing his service duties. The Veteran asserts that he has experienced the same symptoms ever since separating from service. Indeed, while he testified under oath that he did not seek treatment from 1973 through 2005 but did experienced sleep issues during that time period, the record shows that in 2004, he entered into a Compensated Work Therapy (CWT) program through VA, and progress notes in June and July 2004 specifically note that the Veteran sometimes slept on the job. In October 2007, the Veteran was formally diagnosed with obstructive sleep apnea, and at that time he told his provider that he had experienced snoring and apnea symptoms for many years. VA medical records show that the Veteran has been treated for sleep issues through the present. Although the AOJ obtained a medical opinion addressing the etiology of the Veteran’s sleep apnea in February 2020, such did not address whether any other sleep disorder might be related to service. Moreover, in opining against a relationship between sleep apnea in particular and service, the examiner based the opinion largely on absence of documented treatment or diagnosis for sleep apnea, and suggested that insomnia has different causes than sleep apnea, without further discussion. In light of the foregoing, the Board finds that another examination is necessary that considers whether service connection is warranted for any sleep disorder, and that takes into consideration the Veteran’s contentions that he has considered the same symptoms from service through the present. The matter is REMANDED for the following action: 1. Schedule the Veteran for appropriate examinations to address the nature and etiology of the Veteran’s claimed sleep disorders, including sleep apnea, insomnia, and delayed sleep phase syndrome (DSPS). If an examination cannot be scheduled at a location to which the Veteran can safely travel, or if health considerations make the scheduling of an in-person examination not possible, the AOJ should consider whether other virtual options, to include telehealth interviews or examinations are possible. If virtual alternatives are not feasible or possible, the AOJ should indicate as much, and medical opinions based on review of the Veteran’s claims file should be obtained, in lieu of an in-person or virtual examination, addressing the etiology of the Veteran’s claimed disabilities. The claims file should be sent to, and reviewed by the examiner. The examiner should take a history from the Veteran as to the progression of his sleep impairment. Upon review of the record, the examiner is asked to respond to the following: Is it at least as likely as not (50 percent or greater probability) that any of the Veteran’s sleep disorders, including obstructive sleep apnea, insomnia, or DSPS, had onset in, or are otherwise related to the Veteran’s period of active service? In providing a response to the answer above, the examiner should consider (i) the notations in the Veteran’s service treatment records showing that he sought treatment for somnolence and other sleep issues, to include his statement that his sleep issues began after he sustained blunt trauma to his cervical spine, and was discharged from service on the basis of his poor performance related to his sleep issues; (ii) his sworn testimony that he did not seek medical treatment for sleep issues between separation from service and 2005; and (iii) VA medical records dated from 2003 through the present showing ongoing treatment for sleeping problems, to include sleep apnea, insomnia, and DSPS. The examiner must also consider the Veteran’s assertions and statements regarding the onset and continuity of his sleep symptoms. All opinions should be supported by a medical explanation or rationale. 2. Then, readjudicate the appeal. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Polly Johnson, 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.