Citation Nr: 21003906 Decision Date: 01/25/21 Archive Date: 01/25/21 DOCKET NO. 17-31 152 DATE: January 25, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea on a direct service connection basis or as caused by service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from June 1971 to April 1973. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified at a hearing before the undersigned; a transcript of that hearing is of record. In February 2020, the Board found that the Veteran’s service-connected PTSD aggravated his sleep apnea and granted service connection on a secondary aggravation basis. The Board remanded the issue of whether it was caused by his service or caused by service-connected PTSD to the RO for further evidentiary development.   Entitlement to service connection for obstructive sleep apnea on a direct service connection basis or as caused by service-connected PTSD is remanded. As noted above, the claim was remanded in February 2020. The Board directed the RO to obtain VA treatment records from April 2017 forward and arrange an examination and medical opinion for the Veteran’s obstructive sleep apnea, particularly as to whether it was at least as likely as not related to or attributable to his military service or caused by his service-connected PTSD. The Board asked the examiner to consider an article from the Journal of Clinical Sleep Medicine which was submitted by the Veteran. In August 2020, an examination and medical opinion were prepared. The examiner opined that it was less likely than not that the Veteran’s sleep apnea was caused by his service or his PTSD because “at the time of [the] sleep study veteran was obese which is the likely contributor to sleep apnea.” The examiner did not address the Veteran’s December 2019 testimony before the Board about his lack of sleep during active duty service, or the article from the Journal of Clinical Sleep Medicine. He also did not explain the basis for his conclusion that the Veteran was obese at the time of the sleep study. A VA examiner must consider all relevant evidence of record, including lay statements. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008), Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). As the August 2020 examination is inadequate and did not substantially comply with the Board’s prior remand directives, remand is necessary to obtain an addendum opinion. Additionally, prior to the examination, the RO did not obtain updated VA treatment records as directed in the Board’s February 2020 remand. Therefore, there also has not been substantial compliance with this remand directive and remand is necessary to obtain these records.   The matter is REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from April 2017 to the present. 2. After completing the development in item 1, obtain an addendum opinion from an appropriate clinician. The clinician is asked to provide opinions on the following questions: (a.) Is it at least as likely as not that the Veteran’s sleep apnea is related or attributable to his military service, to include his duties with a Fighter Squadron in Vietnam? (b.) Is it at least as likely as not that the Veteran’s service-connected PTSD caused the Veteran’s sleep apnea? In providing an opinion on these questions, the examiner should address (1) the Veteran’s testimony that he was deprived of sleep during his active duty service and (2) the medical study in the Journal of Clinical Sleep Medicine cited by the Veteran. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not   be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Dean 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.