Citation Nr: 21061919 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-11 121 DATE: October 5, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1971 to January 1973. The claim was most recently before the Board in November 2020 when it was remanded for further development. There has not been substantial compliance with the remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for sleep apnea is remanded. The claim must be remanded again because the February 2021 VA opinion obtained on remand is inadequate. The February 2021 VA medical opinion, while noting the Veteran's reports of a history of sleep problems, relies on a lack of objective evidence of sleep apena, to include treatment, during or immediately following active duty service. The Board finds that this opinion remains inadequate because, despite specific directives to do so, the examiner did not address why the Veteran's competent statements regarding experiencing sleep issues since active duty service do or do not represent manifestations of sleep apnea. 2. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD is remanded. The claim must be remanded again because the July 2021 VA opinion is inadquate. The July 2021 examiner concluded that the Veteran does not have a current psychiatric disorder or symptoms. However, the examiner also conceded that the Veteran has a "history of past psychiatric treatment" apparently ending in 2016. Also, an April 2015 VA examination diagnosed unspecified depressive disorder. The examiner did not provide any opinion as to those diagnoses. The opinion on remand must address any psychiatric diagnoses noted during the pendency of the appeal. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician as to 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 must answer the following: (a) Is it at least as likely as not that the sleep apnea is related to service? Why or why not? In answering this question, the examiner must discuss the Veteran's competent reports of sleep problems that have existed since active-duty service and cannot rely on the lack of corresponding treatment records to discount these reports. If the examiner finds that these lay reports do not represent evidence of sleep apnea, the examiner must explain why. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Obtain an addendum opinion from an appropriate clinician as to the nature and likely etiology of any psychiatric disability diagnosed since January 2015. Copies of all pertinent records should be made available to the examiner for review. The examiner must answer the following: (a) Identify all psychiatric diagnoses since January 2015. The examiner must specifically discuss the April 2015 diagnosis of unspecified depressive disorder and the July 2021 examiner's reference to a "history of past psychiatric treatment." (b) Is it at least as likely as not that any psychiatric diagnoses since January 2015 were incurred in or otherwise directly related to service? Why or why not? A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.S. McLeod 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.