Citation Nr: 21004392 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 18-00 289A DATE: January 27, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected bilateral knee disorders is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the U.S. Army from September 1979 to September 1982 and from November 2001 to May 2004. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in March 2020. 1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected bilateral knee disorders, is remanded. The Veteran asserts his diagnosed sleep apnea is due to his service-connected bilateral knee disorders. See March 2015 sleep study; see March 2020 hearing testimony. Specifically, he asserts his physician told him that the sleep apnea was due to obesity, and the Veteran asserts his obesity is due to the bilateral knee disorders that prevent him from exercising. On his substantive appeal, the Veteran wrote that his wife had noticed his snoring and interrupted breathing for years. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2019). VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The Veteran has not yet been afforded a VA examination. Here, there is a currently diagnosed disability and an indication that sleep apnea may be etiologically related to the service-connected bilateral knee disorders. Thus, remand for an examination and opinion are necessary. McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting an examination is necessary when the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). Last, on remand efforts must be made to identify and obtain outstanding and relevant VA or private treatment records. 38 C.F.R. § 3.159(c)(1)(2019); Dunn v. West, 11 Vet. App. 462 (1998); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of his obstructive sleep apnea. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that sleep apnea had onset in, or is otherwise related to, active military service. (b.) The examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the sleep apnea is caused or aggravated by the service-connected bilateral knee disorders. (c.) The examiner must specifically address 1) the Veteran’s assertions that he is unable to exercise as a result of his bilateral knee condition, is overweight as a result, and that his sleep apnea is therefore caused or aggravated by the service-connected bilateral knee disorders; and 2) the March 2015 sleep study. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Smith, 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.