Citation Nr: 20009771 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 14-41 932 DATE: February 6, 2020 REMANDED Entitlement to service connection for sleep apnea, to include as due to in-service herbicide agent exposure or as secondary to the service-connected ischemic heart disease, is remanded. Entitlement to service connection for atrial fibrillation, to include as due to in-service herbicide agent exposure or as secondary to the service-connected ischemic heart disease, is remanded. REASONS FOR REMAND The Veteran had active service from June 1968 to July 1971. In June 2018, this case was remanded by the Board of Veterans’ Appeals (Board) for further evidentiary development. Entitlement to service connection for sleep apnea, to include as due to in-service herbicide agent exposure and/or as secondary to the service-connected ischemic heart disease Entitlement to service connection for atrial fibrillation, to include as due to in-service herbicide agent exposure and/or as secondary to the service-connected ischemic heart disease The Veteran contends that his sleep apnea and atrial fibrillation are due to his conceded in-service exposure to herbicide agents. Alternatively, he asserts that his sleep apnea and atrial fibrillation are caused by his service-connected ischemic heart disease. The Veteran’s VA treatment records show diagnoses of sleep apnea and atrial fibrillation. The Board regrets the additional delay caused by this second remand in this appeal. However, another remand is necessary before the Veteran’s claims can be adjudicated. In July 2019, the Veteran submitted medical journal articles in support of his assertions that his sleep apnea and atrial fibrillation are due to his service-connected ischemic heart disease. The articles are entitled, “Sleep Apnea and Cardiovascular Disease, An Enigmatic Risk Factor;” “Poor sleep is associated with ischemic heart disease and stroke;” and “Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis.” In his July 2019 lay statement, the Veteran made references to an article published in the Huffington Post, which cites to VA statistics indicating that one out of every five war veterans has been diagnosed with sleep apnea. He also referred to a Mayo Clinic website article stating that anyone with heart disease has an increased risk of atrial fibrillation. As these journal articles have not been reviewed by a medical professional, and as review is necessary in order to assess their probative value, a remand is necessary for a VA medical professional to evaluate the substance of these articles in relation to the Veteran’s contentions - i.e., a link between his service-connected ischemic heart disease and: 1) sleep apnea; 2) atrial fibrillation. These matters are thus REMANDED for the following actions: 1. Forward the Veteran’s claims file, including a copy of this remand, to a qualified VA medical professional for addenda medical opinions regarding the etiology of the Veteran’s sleep apnea and atrial fibrillation. The need for additional examinations is left to the discretion of the medical professional(s) offering the addenda opinions. For sleep apnea, the examiner is asked to opine: a. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s sleep apnea is related to service, to include his presumed exposure to herbicides. b. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s sleep apnea was caused by his service-connected ischemic heart disease. c. Whether the Veteran’s sleep apnea is at least as likely as not aggravated (i.e., made worse) by his service-connected ischemic heart disease. Importantly, the examiner must discuss the articles submitted by the Veteran in July 2019, including the articles entitled, “Sleep Apnea and Cardiovascular Disease, An Enigmatic Risk Factor;” “Poor sleep is associated with ischemic heart disease and stroke;” as well as the Huffington Post article which cites to VA statistics indicating that one out of every five war veterans has been diagnosed with sleep apnea. For atrial fibrillation, the examiner is asked to opine: a. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s atrial fibrillation is related to service, to include his presumed exposure to herbicides. b. Whether it is at least as likely as not (a probability of 50 percent or greater) that the Veteran’s atrial fibrillation was caused by his service-connected ischemic heart disease. c. Whether the Veteran’s atrial fibrillation is at least as likely as aggravated (i.e., made worse) by his service-connected ischemic heart disease. The examiner must discuss the article submitted by the Veteran in July 2019, entitled, “Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis” and the Mayo Clinic website article stating that anyone with heart disease has an increased risk of atrial fibrillation, which indicate a possible relationship between atrial fibrillation and ischemic heart disease. The examiner is advised that the Veteran is competent to report his symptoms and history and that such reports must be acknowledged and considered in formulating any opinion. A complete rationale for all opinions expressed must be provided. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Trowers, 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.