Citation Nr: 20034594 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 18-38 853 DATE: May 18, 2020 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as to service-connected PTSD is remanded. Entitlement to service connection for cardiovascular disease is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1961 to June 1966. This matter comes before the Board of Veterans Appeals (Board) on an April 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared for a hearing in March 2020 before the undersigned Veteran’s Law Judge. A transcript of the hearing is of record. 1. Entitlement to service connection for obstructive sleep apnea (OSA), to include as to service-connected PTSD is remanded. Upon review, the Board finds that remand is required for a new medical examination and opinion. The Veteran’s STRs and corresponding VA treatment show continued treatment for sleepiness and fatigue. The Veteran has been diagnosed with OSA. See July 2016 VA Treatment Records. The Veteran was afforded a VA examination in February 2017 for his OSA condition. A negative opinion was provided as to direct service connection, with the accompanying rationale stating a physician ruled out narcolepsy in 1965 and that the Veteran’s first reports of snoring occurred in 2010 which makes it highly unlikely that he had sleep apnea in 1963. A March 2017 addendum opinion concerning secondary service connection as to the Veteran’s OSA and PTSD was additionally provided. The examiner’s rationale stated that PTSD is mental illness that does not cause airway obstruction. The Board finds that the February 2017 and March 2017 VA examination addendum opinion inadequate to decide the claim, as they do not provide an complete rationale that address potential aggravation between the Veteran’s OSA and service-connected PTSD. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). 2. Entitlement to service connection for cardiovascular disease and hypertension is remanded. The Veteran contends that his current CAD and hypertension conditions are related to his active-duty service, specifically that both conditions are aggravated by his OSA condition. See March 2020 Hearing Transcript. A review of the record indicates that an April 2017 VA medical secondary service connection opinion was furnished concerning the Veteran’s CAD and hypertension diagnoses. However, the Board finds that the record is absent an actual VA examination concerning the Veteran’s CAD and hypertension. Therefore, the April 2017 medical opinion is inadequate, and the Board finds that remand for a new examination is necessary. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (if the medical evidence of record is insufficient, the Board is free to supplement the record by seeking an advisory opinion or ordering a medical examination). Accordingly, the claims are remanded for examinations. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records not already associated with the claims file to the extent possible. 2. Schedule the Veteran for a medical examination to determine the nature, extent, onset, and etiology of his Veteran’s obstructive sleep apnea (OSA). The medical professional must provide an opinion addressing the following: a) Whether it is at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s OSA had its onset during active service? b) Whether it is at least as likely as not that OSA was caused or aggravated by his service-connected PTSD? The claims folder should be made available to the medical professional providing the opinion for review in conjunction with rendering the opinion and the examination report should note that the claims file was reviewed. The examiner should obtain a complete, pertinent history from the Veteran. The medical professional’s attention is invited to the Veteran’s October 1963 STRs concerning treatment for chronic fatigue, February 2017 buddy statement concerning severe sleepiness in the 1960’s, and March 2020 statements concerning history of sleepiness and fatigue. 3. Schedule the Veteran for a medical examination to determine the nature, extent, onset, and etiology of his cardiovascular disease and hypertension. The claims folder should be made available to the medical professional providing the opinion for review in conjunction with rendering the opinion and the examination report should note that the claims file was reviewed. The examiner should obtain a complete, pertinent history from the Veteran. a) The examiner should render an opinion as to whether it is at least as likely as not (a 50 percent or better probability) that any diagnosed cardiovascular disease and hypertension is related to or had its onset during service. The examiner should provide the Veteran with an opportunity to offer a history of his disability. b) Whether it is at least as likely as not that cardiovascular disease and hypertension were caused or aggravated by any service-connected disability beyond natural progression. If the examiner finds aggravation the examiner should indicate to the extent possible the approximate degree of disability or baseline before the onset of the aggravation. Any opinions must be accompanied by a complete rationale. If the examiner is unable to reach an opinion without resort to speculation, he or she should explain the reasons for this inability and comment on whether any further tests, evidence or information would be useful in rendering an opinion. C. TRUEBA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board, R. Smith Department of Veterans Affairs 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.