Citation Nr: 21002168 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 13-16 942 DATE: January 12, 2021 REMANDED Entitlement to service connection for a respiratory disorder, diagnosed as sleep apnea, to include as being due to service in the Southwest Asia Theater of Operations during the Persian Gulf War, is remanded. REASONS FOR REMAND The Veteran had active duty from November 1989 through November 1993, to include service in the Southwest Asia Theater of Operations. The Veteran asserts in a May 2009 claim that he is entitled to service connection for difficulty breathing that began after his service in the Persian Gulf. He asserts also in a June 2009 statement that he was exposed to chemicals from burning oil fields while he performed duties in Kuwait. In August 2014, he filed a supplemental claim in which he asserted that his sleep apnea is secondary to his service-connected PTSD. In a May 2017 remand, the Board construed the Veteran’s claims for service connection for a respiratory disorder and for sleep apnea as comprising a single issue arising out of the Veteran’s May 2009 claim. That issue was remanded for further development. The matter was remanded again by the Board in May 2019. The AOJ has undertaken efforts to complete the ordered development action. For the reasons discussed below, still additional development is necessary. Pursuant to the Board’s May 2019 remand, the matter was referred for an addendum opinion as to whether the Veteran’s sleep apnea is related to or the result of his service in the Southwest Asia Theater of Operations, and/or whether the sleep apnea is caused or aggravated by his service-connected disabilities. In a November 2019 addendum opinion, the examiner acknowledged that existing studies indicate an association between PTSD and sleep apnea but stated that the existence of such an association does not imply a causal relationship. The examiner provided no explanation as to why a causal relationship does not exist between the Veteran’s sleep apnea and his PTSD despite her acknowledgment that an association between the two disorders appears to exist. Also, the examiner gave no opinion as to whether the Veteran’s PTSD has aggravated the Veteran’s sleep apnea beyond its natural progression. Therefore, the claim must be remanded in order to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion concerning the nature and etiology of the Veteran’s sleep apnea from a VA clinician who has not previously examined the Veteran, if possible. The examiner should review the Veteran’s claims file. It is up to the discretion of the examiner if a physical examination of the Veteran is needed to render the requested opinions. The examiner should address the following questions: (a) is it at least as likely as not (at least a 50 percent probability) that the Veteran’s sleep apnea was incurred during or resulted from an injury, illness, or event that occurred during his active duty service, to include exposure to environmental hazards during his service in the Southwest Asia Theater of Operations? (b) is it at least as likely as not that the Veteran’s sleep apnea is caused by his service-connected disabilities, to include PTSD and lumbar strain? (c) is it at least as likely as not that the Veteran’s sleep apnea is aggravated beyond its natural progression by his service-connected disabilities, to include PTSD and lumbar strain? In answering (b) and (c), please address any medical literature that suggests there is an association between PTSD and sleep apnea, to include the articles referenced in the Veteran’s representative’s October 2020 brief. The examiner must provide a complete rationale that explains fully all the reasons for the given opinions. 2. After completion of the above development, the issue on appeal should be readjudicated. If the determination remains averse to the Veteran, he and his representative should be furnished with a SSOC and be given an opportunity to respond. REBECCA N. POULSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.S. Lee 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.