Citation Nr: 21000969 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 15-41 987 DATE: January 6, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected bipolar disorder with symptoms of depression, anxiety, and insomnia (psychiatric disability) and/or degenerative arthritis of the cervical spine (cervical spine disability) is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1990 to August 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Additionally, in the Veteran’s November 2015 substantive appeal (VA Form 9), the Veteran requested a Board hearing before a Veterans Law Judge. However, in September 2019, the Veteran withdrew the request for a hearing. Therefore, the Veteran’s request for a Board hearing is considered withdrawn. 38 C.F.R. § 20.704(e). This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c); 38 U.S.C. § 7107(a)(2). Entitlement to service connection for sleep apnea, to include as secondary to a service-connected psychiatric disorder and/or cervical spine disorder is remanded. The Veteran contends that her sleep apnea began during her active military service. In the alternative, the Veteran contends that it is secondary to her service-connected psychiatric condition and/or cervical spine condition. While the Board regrets further delay, it finds that a remand is warranted in order to ensure substantial compliance with the Board’s prior remands. The Board initially remanded the Veteran’s claim in October 2019 to obtain a VA examination and opinion. With regards to direct service connection, the directives requested that the examiner consider the reports that the Veteran, while on active duty, appeared to stop breathing while sleeping. An opinion addressing direct service connection was obtained in December 2019. However, in its October 2020 remand, the Board found that the opinion was inadequate because it did not consider the Veteran’s reports of symptoms in service, including cessation of breathing while sleeping and fatigue. Thus, the Board remanded the claim in order to obtain a new opinion. Pursuant to the October 2020 remand, a new etiology opinion was obtained in November 2020. While the examiner provided a negative nexus opinion, a review of his rationale again shows that the examiner did not consider the reports of sleep symptomatology in service. Accordingly, the Board finds that a remand is warranted in order to obtain a new etiology opinion that substantially complies with the Board’s prior remands. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Obtain a VA medical opinion regarding the etiology of the Veteran’s sleep apnea from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand. The examiner must opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s sleep apnea had its onset in, or is otherwise related to, active service. In so opining, the examiner should address whether the complaints of fatigue and sleep issues in service (see April 2009 service treatment record; April 2010 out-processing psychiatric evaluation) or the reports that the Veteran snored and stopped breathing while sleeping in service were manifestations of her current sleep apnea. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran’s lay statements. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Mortimer, 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.