Citation Nr: 21004144 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 12-11 455A DATE: January 26, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1969 until May 1972. In March 2015, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This appeal has been before the Board on several prior occasions. Most recently, in June 2020, the Board remanded the matter for an addendum medical opinion. Unfortunately, for the reason described below, there has not been substantial compliance with the remand directives and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded. The Veteran’s representative argued that the most recent VA opinions are inadequate and the Board agrees. See January 2021 written brief. The negative VA opinions provided in July 2020 and September 2020 are inadequate. The July 2020 opinion provider did not appear to consider the Veteran’s sworn testimony that he first had difficulty sleeping while in service after breaking his nose. The basis for finding that the sleep apnea was not aggravated by the Veteran’s service-connected disabilities or the medication prescribed to treat those disabilities was because there was a lack of consensus in the literature. The examiner did not attempt to provide an opinion based on the specific facts of this Veteran’s case. Another remand is required to obtain addendum medical opinions to address both direct and secondary service connection theories of entitlement. Additionally, in the December 2020 brief, the Veteran’s representative stated, “[t]here have been medical studies published that have linked sleep apnea to PTSD.” There were no specific studies cited. On remand, the Veteran and his representative should be provided an opportunity to provide the full text of any medical studies he wishes to have considered. The representative also noted that the examiner did not consider the impact of the Veteran’s service-connected residuals of a fractured nose on his breathing and thus any possible relationship to sleep apnea. The opinion on remand must address that argument. The matters are REMANDED for the following action: 1. Ask the Veteran and his representative to submit specific information as to the study or literature he wishes to have considered in connection with this claim of service connection for sleep apnea. 2. After providing the Veteran with an opportunity to submit any studies or literature he would like to be considered, obtain an addendum medical opinion from an appropriate clinician regarding the likely etiology of the Veteran’s diagnosed sleep apnea. Copies of all pertinent records must be made available to the examiner for review. The examiner should be provided with all pertinent records, including a copy of this remand. The examiner should answer the following: (a.) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed sleep apnea disorder was incurred in or is otherwise related to service? (b.) If the answer to (a) is no, is it at least as likely as not (50 percent or greater probability) that any currently diagnosed sleep apnea disorder is proximately due to (caused by) the Veteran’s service-connected disabilities (including a psychiatric disorder; back disability,; and residuals of a fractured nose)? (c.) If the answer to (a) and (b) is no, is it at least as likely as not (50 percent or greater probability) that any currently diagnosed sleep apnea disorder has been aggravated (defined as any increase in disability) by the Veteran’s service-connected disabilities or by any medication used to treat his service-connected disabilities? All opinions must be supported by complete rationale, citing to supporting factual data and medical literature and considering and addressing, as appropriate, any literature or studies submitted by the Veteran. If the opinion provider cannot provide a requested opinion without resort to speculation, they should say why. The examiner is asked to discuss whether any of the Veteran’s prescribed medications to treat his service-connected disabilities proximately caused or aggravated his sleep apnea disorder. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.