Citation Nr: 20039996 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 17-47 399 DATE: June 11, 2020 REMANDED Entitlement to service connection for a sleep disorder (claimed as sleep disturbances) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2001 to July 2005. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. A hearing was held before the undersigned Veterans Law Judge in June 2019. A transcript of that proceeding has been associated with the claims file. The Board remanded the case further development in September 2019. The case has since been returned to the Board for appellate review. Upon review, the Board finds that additional development is needed prior to adjudication of the claim. Following the prior remand, a February 2020 VA examiner opined that the Veteran’s unspecified sleep-wake disorder is less likely than not caused by or due to any event or condition that he experienced while on active duty. She explained that the Veteran's sleep is adversely impacted by multiple factors, including mild REM-related obstructive sleep apnea, which was diagnosed in 2015. He had also reported a weight gain of over 40 pounds since the sleep study was conducted, and a medical provider stated in August 2018 that she suspects that his obstructive sleep apnea has worsened with weight gain. In addition, the examiner noted that the Veteran has alcohol use disorder and indicated that the over-use of alcohol is well-known to interfere with sleep. She also indicated that another factor with the Veteran’s sleep is shift work, as he currently worked night shift, which has been shown to have negative effects on sleep and various health outcomes. The examiner further stated that another complicating factor is the unreliability of the Veteran's self-report, as there is objective evidence from psychological testing with validity measures of major problems with his self-report of symptoms. Notably, the February 2020 VA examiner noted the Veteran’s diagnosis of obstructive sleep apnea, but she did not specifically opine as to whether that disorder is related to military service, to include any symptomatology therein. Rather, the examiner simply stated that the Veteran’s sleep is disrupted by multiple factors, including sleep apnea, excessive alcohol intake, and shift work. Therefore, the Board finds that a clarifying VA medical opinion is needed to determine the nature and etiology of the Veteran’s obstructive sleep apnea. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: 1. The agency of original jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for a sleep disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. After completing the foregoing development, the AOJ should refer the Veteran’s claims file to a suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of the Veteran’s obstructive sleep apnea. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s obstructive sleep apnea manifested in or is otherwise causally or etiologically related to his military service, including any symptomatology therein. (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 conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. The AOJ should review the examination report to ensure compliance with this remand. If the report is deficient in any manner, the AOJ should implement corrective procedures. 4. After completing the above actions and any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.S. Chilcote, 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.