Citation Nr: 20031072 Decision Date: 05/04/20 Archive Date: 05/04/20 DOCKET NO. 19-19 088 DATE: May 4, 2020 REMANDED Entitlement to service connection for a sleep disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1984 to September 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, a VA examiner reviewed the Veteran’s records to access the etiology of his currently diagnosed sleep apnea condition. The examiner provided a medical opinion as to whether the Veteran’s sleep disorder is at least as likely as not (50 percent or greater probability) incurred in or caused by the sleep condition during service. The examiner opined that the sleep condition was less likely than not incurred in or caused by service. The rationale was that the Service Treatment Records (STRs) only contain one complaint of a sleep problem lasting several weeks and no other entries of sleep difficulties. The Board finds the October 2018 medical opinion to be inadequate for adjudicative purposes. The examiner provided no rationales for its conclusions other than stating that there was a lack of multiple complaints during service. Unfortunately, the Board finds this insufficient. The examiner must provide reasoned rationales and bases for stated conclusions and the examiner failed to do so in this instance. Any negative opinion may not be based solely on the lack of documented evidence of injury in the service treatment records, in accordance with the United States Court of Veterans Appeals (Court) opinion in Dalton v. Nicholson, 21 Vet. App. 23 (2007). Accordingly, a remand is necessary in order to obtain an addendum opinion to adequately address the theory of direct service connection. On remand, the examiner is specifically requested to provide an adequate opinion with reasoned bases and rationales for every conclusion stated. An opinion on the etiology of the Veteran’s sleep condition must include a discussion of all the pertinent evidence of record, not only the lack thereof. The matter is REMANDED for the following action: 1. Obtain an addendum opinion by a suitably qualified health care professional to determine the nature and etiology of the Veteran’s sleep apnea condition. An examination of the Veteran should only be scheduled if the examiner determines one is necessary to obtain the requested opinions. The claims file, to include a copy of this remand must be made available to the examiner for review, and the examination report should reflect that such a review was accomplished. After review of the claims file, including the Veteran’s STRs, the examiner should respond to the following question: a. Does the Veteran have a diagnosis of a sleep disorder that is at least as likely as not (50 percent or greater probability) incurred in or caused by active duty service? The examiner must specifically review and discuss the evidence of record and provide an opinion supported by reasons and bases. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. A complete rationale must be provided for all opinions offered. If any opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence would potentially allow for a more definitive opinion. Cynthia M. Bruce Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Nelson, 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.