Citation Nr: 21001657 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 10-07 062 DATE: January 11, 2021 REMANDED The claim for service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected post-traumatic stress disorder (PTSD) and asthma, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from March 2000 to February 2007. The matter is on appeal from an August 2009 rating decision. In October 2019, the Board denied the Veteran service connection for OSA to include as secondary to PTSD and asthma. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In July 2020, the Court issued a Joint Motion for Remand (JMR), in which the Board’s October 2019 decision was vacated and the issue was remanded for further development and adjudication. Service Connection OSA In the July 2020 JMR, the Court found that the July 2019 VA examination offered an inadequate rationale for its conclusion that the Veteran’s OSA was not caused or aggravated by his asthma. Specifically, the parties that the examiner failed to provide an adequate rationale on the issue of causation when they failed to explain whether OSA was more prevalent among patients with Veteran’s level of asthma. That is, the examiner’s rationale focused on how OSA is more prevalent among patients with severe asthma than patients with moderate asthma, but did not explain whether OSA is more prevalent in patients with the Veteran’s level of asthma than patients without asthma. Additionally, the JMR found that the examiner did not adequately explain their reasons for finding that the Veteran’s asthma was less likely than not caused by OSA. The examiner failed to offer an adequate rationale on the issue of aggravation when they failed to address the Veteran’s asthma’s impact on the severity of his OSA. Again, the examiner’s rationale focused on how OSA is more prevalent among patients with severe asthma than patients with moderate asthma and did not address whether the Veteran’s asthma, irrespective of whether it caused his OSA, caused an increase in the severity of his OSA such that it aggravated it. Accordingly, a remand is warranted to provide the Veteran with a new examination that provides an adequate rationale pertaining to whether the Veteran’s OSA was caused by or otherwise aggravated by his asthma. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the etiology of his OSA. The examiner should answer the following questions: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s OSA was caused by his service-connected asthma? Why or why not? The examiner should review take into account the July 2020 JMR to understand why the July 2019 VA sleep apnea examination and opinion was found to be inadequate. (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s OSA was aggravated (made worse) by his service-connected asthma? Why or why not? The examiner should take into account the July 2020 JMR, and the July 2019 VA sleep apnea examination. If aggravation is found, the examiner should identify the baseline level of severity of the OSA created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the OSA. If such cannot be done, then it should be explained why. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Lutgens-Staley, 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.