Citation Nr: 20045653 Decision Date: 07/08/20 Archive Date: 07/08/20 DOCKET NO. 14-29 839 DATE: July 8, 2020 REMANDED Entitlement to service connection for headaches is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active military service from October 1974 to October 1980. The Board of Veterans’ Appeals (Board) remanded the claims for additional development in June 2018. There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for headaches is remanded. The Veteran asserts that his current headache disability arose during or as a result of his active service. The Veteran is service-connected for major depressive-disorder with psychotic features, hearing loss, tinnitus, and thoracolumbar strain. During a December 2014 hearing before a Decision Review Officer (DRO), the Veteran stated that he currently experienced chronic headaches, which he believed were caused by his high blood pressure and stress. Neither the March 2015 or November 2019 VA examinations for headache conditions addressed the likelihood that the Veteran’s disability was caused or aggravated by his service-connected disabilities. Accordingly, this claim must be remanded for an additional VA examination to address these theories of entitlement. Entitlement to service connection for sleep apnea is remanded. The Veteran asserts that he experiences sleep apnea that arose during or as a result of his active service. The claim must be remanded again for an adequate opinion. VA treatment records include a diagnosis for sleep apnea in April 2015. In January 2019, the Veteran was noted to experience sleep apnea with abnormal pauses during his sleep. His treatment records consistently reflect CPAP usage to treat sleep problems. Conversely, during the Veteran’s November 2019 VA examination for sleep apnea, the examiner ruled that that the Veteran did not meet the criteria sleep apnea diagnosis, as the criteria recommended a split-night study, which the Veteran had not undergone. Consequently, the examiner opined that the Veteran’s condition was less likely than not related to service. These conclusions were based on the findings from a January 2015 preliminary sleep study. The examiner did not state whether the Veteran met the criteria for any other sleeping disorder. The November 2019 opinion is inadequate as it does not address the earlier findings that reflect sleep apnea or another sleep disorder. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. After completion of the above, Obtain an addendum medical opinion from the November 2019 VA examiner, or, if that examiner is not available, from another appropriate clinician, to determine the nature and etiology of any headache or migraine disability present during the period on appeal. Copies of all pertinent records must be made available to the examiner for review. Based on the examination results and the review of the record, the examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or better probability) that any headache disability present during the period on appeal was caused by the Veteran’s service-connected disabilities? Why or why not? (b.) Is it at least as likely as not (50 percent or better probability) that any headache disability present during the period on appeal was aggravated (defined as any increase in disability) by the Veteran’s service-connected disabilities? Why or why not? A complete rationale should be provided for all conclusions. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. If accurate diagnoses and adequate supporting opinions can be provided without an in-person examination, then an in-person examination is not necessary. 3. Then, schedule the Veteran for a VA examination to determine the nature and etiology of any sleep apnea or sleeping disorder present during the period on appeal. Copies of all pertinent records must be made available to the examiner for review. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that sleep apnea or sleeping disorder present during the period on appeal is etiologically related to the Veteran’s active service. Why or why not? The examiner must specifically comment on the finding of fatigue noted in service. A complete rationale should be provided for all conclusions. The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination. If accurate diagnoses and adequate supporting opinions can be provided without an in-person examination, then an in-person examination is not necessary. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Hicks, 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.