Citation Nr: 20022085 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 18-41 412 DATE: March 30, 2020 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1974 to March 1980, from July 1994 to November 1994, from February 1996 to July 1996, from January 1999 to September 2010, from November 2010 to January 2011, from November 2011 to January 2012, to include service in the Southwest Asia theater of operations during the Persian Gulf War. See 38 C.F.R. §§ 3.2(i), 3.317(e); service personnel records (noting service in Iraq, Kuwait, and Afghanistan). He also had service in the Army National Guard and United States Army Reserve. His decorations include the Combat Action Badge. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Pittsburgh, Pennsylvania. The Veteran initially requested a video-conference hearing before a Veterans Law Judge of the Board in conjunction with the issue presently on appeal. See August 2018 VA Form 9. However, he later expressed his desire to withdraw that request. See September 2018 attorney statement (“The [V]eteran waives his previously-requested BVA videoconference hearing . . . .”); September 2019 statement of the Veteran (“I hereby repeat my waiver of a B[oard] hearing in order to expedite the B[oard’s] action on my sleep apnea issue on appeal.”). Thus, pursuant to 38 C.F.R. § 20.603(e), the hearing request is deemed withdrawn. In September 2019, the Board issued a decision addressing other issues that were in appellate status. In doing so, the Board declined jurisdiction over the Veteran’s sleep apnea claim on grounds that a hearing had been requested as to that issue. The Veteran filed a motion for reconsideration of the Board’s decision, citing disagreement with the decision to decline jurisdiction over the sleep apnea claim. In February 2020, the Board dismissed that motion, explaining that the September 2019 Board decision “did not constitute a final decision on the merits of the appeal of entitlement to service connection for sleep apnea.” Entitlement to service connection for sleep apnea is remanded. The Veteran essentially argues that the existing VA medical opinion is inadequate because it (1) did not address the theory of secondary service connection, (2) relied on an inaccurate factual premise when it cited risk factors of obesity, smoking history, and family history that do not apply to the Veteran; and (3) lacked an adequate rationale. See September 2018 statements from the representative and Veteran. After reviewing the evidence of record, the Board agrees that the theory of secondary service connection has been duly raised and that a VA medical opinion is needed to address whether his service-connected sarcoidosis may have caused or aggravated his diagnosed sleep apnea. On remand, in conjunction with providing an opinion, the examiner should review the medical articles submitted by the Veteran in September 2018, entitled, “Sarcoidosis and Obstructive Sleep Apnea: Yet another Overlap Syndrome?,” “Sleep Apnea in Sarcoidosis,” and “Sleep-disordered Breathing Secondary to Sarcoidosis.” Further, the Board finds that a clarifying opinion as to direct service-connection is needed in order to address whether the Veteran’s sleep apnea may be related to in-service symptoms of fatigue, insomnia, chest congestion/cough, and paroxysmal nocturnal dyspnea that are noted in the service treatment records. See, e.g., June 2006 service treatment record (including insomnia in the active problem list); May 2008 service treatment record (congested in the chest, cough dry, and causing awakening from sleep); October 2009 service treatment record (noting paroxysmal nocturnal dyspnea causing awakening); December 2009 service treatment records (acknowledging fatigue dating back to October 2009 Lyme disease diagnosis). Additionally, the Veteran submitted an article entitled “Iraq & Afghanistan Burn Pit Chemical Exposure Cancer & Disease Claims,” which found that “exposure to [sodium dichromate, which was spread across a ruined water-injection facility in Iraq when soldiers were there in 2003] may produce . . . sleep apnea.” Because the Veteran’s DD Form 2014 indicates that he served in Kuwait/Iraq from March to May 2004, the examiner should review this information and any possible exposure to sodium dichromate or other chemicals during his deployments, such as those mentioned in an April 2011 Army Memorandum of record concerning “Air Quality Summary on Bagram Air Field (BAF).” This matter is REMANDED for the following action: 1. Obtain an addendum medical opinion regarding the etiology of the Veteran’s sleep apnea. The examiner should review record and offer opinions as to each of the following questions: (a) whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran’s sleep apnea is related to any period of active service, including reported symptoms of fatigue, insomnia, chest congestion/cough, and/or paroxysmal nocturnal dyspnea that are noted in the service treatment records in June 2006, May 2008, October 2009, and December 2009. (b) whether it is at least as likely as not that the Veteran’s sleep apnea is related to any possible exposure to sodium dichromate in Iraq (see article entitled “Iraq & Afghanistan Burn Pit Chemical Exposure Cancer & Disease Claims”) or other chemicals/burn pits exposure during his Gulf War deployments (see April 2011 Army Memorandum entitled “Air Quality Summary on Bagram Air Field (BAF)”); and (c) whether it is at least as likely as not that the Veteran’s sleep apnea diagnosed is either caused OR aggravated (i.e., worsened beyond the natural progression) by his service-connected sarcoidosis. In providing this opinion, the examiner is requested to discuss the medical articles submitted in September 2018, entitled “Sarcoidosis and Obstructive Sleep Apnea: Yet another Overlap Syndrome?,” “Sleep Apnea in Sarcoidosis,” and “Sleep-disordered Breathing Secondary to Sarcoidosis.” A complete medical rationale for all opinions expressed must be provided. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental   statement of the case. An appropriate period of time should be allowed for response. DAVID A. BRENNINGMEYER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Gielow, 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.