Citation Nr: 20021619 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 18-17 478 DATE: March 26, 2020 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1972 to August 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for OSA The Veteran contends that his currently diagnosed OSA is related to his military service. Specifically, he argues that the onset of his OSA symptoms, to include snoring, began in service. See March 2018 Form 9. Additionally, the Veteran’s spouse submitted a statement that beginning in approximately 1983, she noticed that the Veteran snored loudly and stopped breathing in his sleep. See March 2017 Statement in Support of Claim. She explained that she would physically wake the Veteran from his sleep so that he would start breathing again and that the Veteran currently experiences constant fatigue. Id. The Board notes that the Veteran is competent to report his symptoms of sleep apnea and his spouse is also competent to report perceived symptoms of his disability. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The record does not include a VA examination or medical opinion addressing whether the Veteran’s OSA is related to his military service. Given the Veteran’s current diagnosis and his competent reports as to the onset of symptoms related to such disability, a VA examination is necessary to determine whether the Veteran’s disability is related to service. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Additionally, the Board finds that the evidence of record has raised the issue of entitlement to service connection for OSA as secondary to the Veteran’s service-connected disabilities, to include asthma, deviated nasal septum with allergic rhinitis, and sinusitis. In this regard, the Veteran noted that he initially believed his problems with snoring were related to his asthma, allergic rhinitis, and deviated septum and was unaware of sleep disorders until after his separation from service. See March 2018 Form 9. The Veteran’s spouse also indicated that the Veteran is unable to use a continuous airway pressure (CPAP) machine for his OSA because of his breathing difficulties caused by his service-connected deviated septum and sinus disorders. See March 2017 Statement in Support of Claim. Finally, a June 2015 VA respiratory conditions examination report reflects that the Veteran reported that his asthma symptoms interrupt his sleep. As such, on remand a VA medical opinion should also be obtained to address whether the Veteran’s OSA is proximately due to or aggravated by his service-connected disabilities. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any and all outstanding VA treatment records relevant to the Veteran’s claims on appeal. The last VA treatment of record is dated May 2017. 2. After securing any necessary authorization, obtain any private treatment records as the Veteran may identify relevant to his claim. 3. Then, schedule the Veteran for a VA examination to determine the nature and origin of his OSA. The claims file, including a copy of this remand, should be made available to and be reviewed by the examiner. An opinion as follows is requested: Is it at least as likely as not (50 percent probability or greater) that the Veteran has a sleep disorder, to include OSA, that (1) had an onset in service; (2) is otherwise related to service; OR (3) was caused or aggravated by the Veteran’s service-connected disabilities, to include asthma, deviated nasal septum with allergic rhinitis, and sinusitis? If aggravation is found, the examiner should quantify the degree of aggravation, if possible. State whether there was an increase in disability regardless of permanence, but medically ascertainable. Any increase in disability should be described in terms of diagnosis, severity, and duration. The examiner should address the Veteran’s reports that he experienced sleep apnea symptoms in service and the report from the Veteran’s spouse that she perceived symptoms of his OSA during his time in service. The examiner should also consider the March 1976 service treatment report where the Veteran reported he had a headache, was generally tired, and had not been getting enough sleep for a week. A clearly stated rationale for any opinion offered should be provided and must not be based solely on the lack of any evidence of a diagnosis of sleep apnea in the Veteran’s service treatment records or immediately thereafter. In this regard, a discussion of the relevant facts and medical principles involved would be of considerable assistance to the Board. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda Purcell, 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.