Citation Nr: 21005219 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 19-29 537 DATE: January 29, 2021 REMANDED Service connection for sleep apnea.   REASONS FOR REMAND The Veteran served on active duty from July 1969 to January 1972. The case is on appeal from an October 2017 rating decision. The Board notes that, in a May 2018 rating decision, the Veteran was denied service connection for skin, tongue, smell, and taste disorders. The Veteran was notified of the decision and provided the proper form to file a notice of disagreement (NOD) later that month, which was mailed to the then current mailing address of record. In April 2019, the Veteran submitted an NOD for these claims on an incorrect form. Effective March 24, 2015, VA amended the claims filing process to require the filing of proper standard forms. Therefore, in January 2021, the Board notified him that the April 2019 submission did not raise an appeal for such claims. Service connection for sleep apnea. The Veteran claims that he has sleep apnea due to service or secondary to service-connected PTSD. In an August 2018 NOD, the Veteran reported experiencing sleep problems during service. His wife stated that the Veteran had sleep problems after returning from service, including stopping breathing while asleep. The Veteran also submitted a December 2006 VA treatment record that shows he reported experiencing snoring and apnea at such time. The Veteran service treatment records (STRs) do not include reports of or treatment for sleep problems during service. An April 1969 entrance examination lists his weight as 132 pounds and a December 1971 separation examination lists his weight as 158 pounds. The separation examination is marked normal for lungs and chest and nothing relevant was noted or reported. The Veteran’s post-service VA treatment records show that he was assessed with probable mild obstructive sleep apnea in September 2008 based on reports of loud snoring and stopping breathing while sleeping. The records also show that he was referred to a private treatment provider in October 2013 for a sleep study. However, the sleep study has not been associated with the file. In a June 2015 statement, the Veteran reported experiencing restless, sleepless nights for many years and attributed this to posttraumatic stress disorder (PTSD). In an April 2017 rating decision, he was granted service connection for PTSD. In May 2017, the Veteran submitted a private sleep apnea Disability Benefits Questionnaire (DBQ) presumably completed by a medical professional. The DBQ notes a diagnosis of obstructive sleep apnea, but does not indicate an etiology for the condition. The RO obtained a medical opinion in regard to this claim in September 2017. The examiner found that the Veteran’s sleep apnea is less likely than not proximately due to or a result of his PTSD. The examiner explained that sleep apnea is caused by an upper airway obstruction as well as obesity. However, the examiner did not indicate if the Veteran’s sleep apnea is aggravated by PTSD. The RO obtained another opinion was obtained in July 2019. The examiner found that the Veteran’s sleep apnea is less likely than not incurred in or caused by service. The examiner reported that the Veteran was diagnosed with mild apnea based on an October 2013 sleep study. The examiner explained that people can experience snoring and apnea without having sleep apnea. The examiner concluded that there is no way to ascertain if the Veteran had sleep apnea during service because he was not evaluated for the condition at that time. On remand, the RO should take all necessary steps to associate the private sleep study resulting in the diagnosis of sleep apnea with the file. Thereafter, the Veteran should be afforded an examination and opinion in regard to this claim. This claim is REMANDED for the following actions: 1. Take all necessary steps to associate the private sleep study performed in or around October 2013 with the file, including obtaining the Veteran’s authorization as necessary. If the sleep study is unavailable, the file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. After completing the records development indicated above, schedule the Veteran for an examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) by an appropriate medical professional to determine the nature and etiology of the sleep apnea. The entire claims file should be reviewed by the examiner. Thereafter, the examiner is asked to: (a.) State whether it is at least as likely as not that the sleep apnea had its onset during service or is otherwise related to an in-service event, disease, or injury. (b.) State whether it is at least as likely as not that the sleep apnea is caused or aggravated by PTSD. Aggravation means an increase in severity beyond the natural progress of the disease. (Continued on the next page)   Consideration should be given as to whether any obesity plays a role in the development of sleep apnea and, if so, whether it constitutes an intermediary step in causation between the sleep apnea and service and/or PTSD. A rationale should be provided for opinions offered. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Jimerfield 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.