Citation Nr: 21002258 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 15-34 984A DATE: January 13, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to his service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served in the United States Army from December 1965 to November 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). By way of procedural history, it is noted that this matter has been before the Board in March 2019. At this time, the Board remanded the matter for additional development, to include obtaining a VA medical opinion. This matter has now returned to the Board for adjudication. The Board notes that the Veteran has a claim for TDIU. In May 2020, the Veteran’s claim for TDIU came before the Board and was remanded for referral to the Director of Compensation Service for extraschedular consideration. See May 2020 Board Decision. However, the Director of Compensation Service is still processing the evidence and has not issued a decision as to the Veteran’s claim for TDIU. Therefore, this issue will not be addressed in this decision and will be the subject of another Board decision. 1. OSA The claim for entitlement to service connection for OSA must be remanded for additional development, as the Agency of Original Jurisdiction (AOJ) has not substantially complied with the Board’s prior remand directives for this claim. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In March 2019, the Board remanded the claim for a new VA medical opinion. Specifically, the Board’s March 2019 remand directed the VA examiner to provide an opinion on “whether the Veteran’s obstructive sleep apnea is at least as likely as not related to his service or proximately due to service-connected PTSD or aggravated beyond its natural progression by service-connected PTSD.” See March 2019 Board Decision. Additionally, the VA examiner was directed to “consider all relevant medical opinions already of record.” See id. Unfortunately, the Board finds the examiner did not comply with the prior Board remand directives. While the examiner opined that the Veteran’s OSA was less likely than not proximately due to, the result of, or aggravated by his service-connected PTSD, the examiner did not address whether his OSA was due to his service. Notably, the Veteran’s service treatment records reflect that the Veteran had complaints of frequent trouble sleeping. Given such, the examiner should have addressed this evidence. . In addition, the examiner did not address the Veteran’s private medical opinions as directed by the March 2019 Board decision directives. Lastly, the Board finds the VA examiner’s rationale in the May 2019 VA medical opinion is inadequate. Specifically, the VA examiner states that medical literature provides ample evidence that there is a co-existence and association between OSA and PTSD. Then, the VA examiner states “[a] causal relationship has not been established.” See March 2019 VA Medical Opinion Disability Benefits Questionnaire (DBQ). The Board finds the VA examiner merely made an assertion that a relationship is not established but fails to explain why it is unestablished. The Board finds this is insufficient and, therefore, cannot provide an informed decision on the Veteran’s claim. Therefore, remand is warranted. The matters are REMANDED for the following action: 1. The RO should return the claim to the examiner who conducted the May 2019 VA medical opinion, or another suitable examiner if the examiner is not available. The examiner should provide an addendum opinion to the May 2019 VA medical opinion. If the examiner determines a new VA examination should be completed, then one must be completed prior to issuing an addendum opinion and RO disposition of the claims. (a.) The examiner should be provided the claims file to include the Veteran’s private medical opinions from February 2020 and October 2013. The examiner should state whether s/he has reviewed the file. The examiner should address the following: (b.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s OSA was related to service. i. The examiner should address the in-service report of frequent sleep trouble. (c.) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s OSA was proximately due to or the result of his service-connected PTSD. i. The examiner should address the February 2020 private medical opinion. ii. The examiner should address the October 2013 private medical opinion. iii. The examiner should address all medical literature considered in the private medical opinions, including, but not limited to, the February 2020 and October 2013 medical opinions. Any opinion expressed by the VA examiner must “contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). 2. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. (continued on the next page) YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Glaeser, 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.