Citation Nr: 21061620 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 14-35 365 DATE: October 4, 2021 REMANDED Entitlement to service connection for a sleep disorder, to include as secondary to service-connected hypoventilation/hypoxia, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 2001 to April 2005, including service in Southwest Asia from March 2003 to December 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In his October 2014 substantive appeal, the Veteran requested a hearing before a Veterans Law Judge. Prior to the scheduling of that hearing he withdrew his request. See February 2014 Personal Appearance Verification. In May 2018, May 2020, and March 2021, the Board remanded this matter for further development. Unfortunately, there has not been substantial compliance with the Board's previous remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Although an examination was provided in May 2021 and an addendum opinion in August 2021, as explained in the Remand section of this decision, those opinions are inadequate. Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Entitlement to service connection for a sleep disorder is remanded. The Veteran and his wife have submitted statements which detailed his sleep symptomatology during his active duty service to the present. See October 2012 Lay Statement; December 2012 Statement in Support of Claim. The Veteran also stated that he had no issues with sleep prior to entering active duty service. See December 2012 Statement in Support of Claim. The Board's March 2021 remand directed the RO to obtain a VA examination which addressed the nature and etiology of the Veteran's claimed sleep disorder. The RO was specifically directed to confirm whether a diagnosis of obstructive sleep apnea is warranted and to provide opinions on direct and secondary service connection. The May 2021 VA examination report confirmed that the Veteran had a diagnosis of obstructive sleep apnea. See May 2021 Sleep Apnea Disability Benefits Questionnaire (DBQ) (noting the June 2011 sleep study with results of AHI-21). The August 2021 addendum opinion only addressed whether the Veteran's sleep apnea was secondary to his service-connected hypoventilation/hypoxia. In reaching this opinion, the examiner provided a negative nexus opinion, rationalizing that the Veteran's hypoventilation/hypoxia were asymptomatic at the time of the examination. See August 2021 Medical Opinion DBQ. The Board finds the August 2021 medical opinion inadequate. First, the opinion only addressed whether the Veteran's sleep apnea was secondary to his service-connected hypoventilation/hypoxia and did not address direct service connection. Second, the August 2021 negative opinion is based on the Veteran's hypoventilation/hypoxia being asymptomatic at the time of the examination. The Veteran has been service-connected for hypoventilation/hypoxia since September 30, 2011. Although this disability may have been asymptomatic at the most recent VA examination, the question of whether the Veteran's sleep apnea is secondary to his hypoventilation/hypoxia remains unsettled. Accordingly, a remand is necessary. Finally, as this matter is being remanded, the Veteran's updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Make arrangements to obtain the Veteran's updated VA treatment records, dated from July 2021, forward. 2. Next, return the claims file to the August 2021 VA examiner for a supplemental opinion. If the August 2021 examiner is not readily available, a VA opinion may be obtained by another medical professional with an appropriate background or expertise. The entire claims file must be reviewed by the examiner in conjunction with the opinion. The examiner should confirm in the examination report that he or she has reviewed the folder in conjunction with the supplemental opinion. After reviewing the claims file, the examiner should offer the following opinions: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea was incurred in or is otherwise related to service, to include his in-service exposure to burn pits. In reaching this opinion, the examiner should consider and address the statements of the Veteran and his wife which detail his sleep symptomatology having its onset on or about December 2003, soon after his return from service in Southwest Asia. See October 2012 Lay Statement; December 2012 Statement in Support of Claim. (b)Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea was either (i) caused by, or (ii) aggravated (i.e., worsened) by the Veteran's service-connected hypoventilation/hypoxia. In reaching this opinion, the examiner should consider and address the impact, if any, of the Veteran's hypoventilation/hypoxia since September 2011 to the present. A complete rationale for all opinions reached must be provided. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. M. Stedman, 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.