Citation Nr: 20051007 Decision Date: 07/31/20 Archive Date: 07/31/20 DOCKET NO. 13-22 976 DATE: July 31, 2020 REMANDED Entitlement to service connection for a sleep disorder, including sleep apnea is remanded. Entitlement to compensation for total disability based on individual unemployability (TDIU) due to service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1982 to August 1998. 1. Entitlement to service connection for a sleep disorder, including sleep apnea is remanded. The Veteran contends his sleep apnea is related to his service or alternatively to his service-connected left foot eczema and scars. The May 2020 examiner provided opinions on causation and aggravation from the left foot conditions, but the opinion addressing direct service connection is inconsistent. The examiner concluded that sleep apnea was at least as likely as not incurred in or caused by the claimed in-service injury or illness. The examiner reasoned that the Veteran suffered from posttraumatic stress disorder (PTSD) while in service, PTSD put him at higher risk for sleep apnea, and he does not have the other traditional risk factors such as high body mass index (BMI) or neck circumference. However, the Veteran is not service connected for PTSD, and service connection for sleep apnea cannot be established through a causal relationship to PTSD. Because the opinion focuses on the connection to PTSD, the examiner did not address the underlying question of direct service connection, and a new opinion is needed. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 2. Entitlement to compensation for TDIU is remanded. The outcome of the claim for a sleep disorder could affect the outcome of the claim for TDIU. As such, that claim is intertwined and also remanded. The matters are REMANDED for the following action: (Continued on the next page)   1. Obtain and associate with the claims file any outstanding VA treatment records. 2. Obtain a new medical opinion for the Veteran’s sleep apnea. The medical expert should review the claims file and address whether the Veteran’s sleep apnea at least as likely as not related to his service. The expert should consider all relevant evidence, including the May 2020 opinion with notice that the Veteran is not service connected for PTSD. All opinions must be supported by detailed rationale. If the opinion cannot be provided without resort to speculation, the expert should explain why, and state whether the inability is due to the absence of evidence or limits of scientific/medical knowledge. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.P. Armstrong, 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.