Citation Nr: 21062121 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 16-53 609 DATE: October 6, 2021 REMANDED The claim for service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served in the U.S. Navy Reserves, to include active duty service from April 2009 to March 2010. The Veteran provided testimony before the undersigned Veterans Law Judge at a September 2019 Board hearing. This issue was previously before the Board in March 2020, and was remanded to obtain an opinion regarding the etiology of the Veteran's OSA. Specifically, the examiner was asked to provide an opinion as to direct service connection, to include burn pits, chemicals, and/or any other hazards and circumstances of service. The examiner was also asked to provide whether the Veteran's OSA was caused by any service-connected disabilities, to include PTSD. The Veteran was afforded a VA examination in April 2020. After a review of the Veteran's claims file, the examiner provided a negative nexus opinion. The examiner explained that OSA was an anatomical abnormality and the important risk factors were advancing age, male gender, obesity and craniofacial morphology or upper airway soft tissue abnormalities. Additional factors identified in some studies included smoking and family history. The examiner concluded by stating that trouble sleeping was likely to be due to multiple reasons and not necessary secondary to sleep apnea. The Board finds the April 2020 VA medical opinion to be inadequate and in non-compliance with the March 2020 Board remand directives. The April 2020 VA examiner did not address whether the Veteran's exposure to burn pits, chemicals, and/or any other hazards and circumstances of service caused the OSA. Further, the examiner did not provide an opinion regarding whether any of the Veteran's service-connected disabilities caused or aggravated his OSA. The Board regrets that another remand will further delay a decision in this case, but finds that another remand is necessary so that it can make a fully informed decision. Under Stegall, a remand by the Board confers on the veteran the right to compliance with its remand orders. Id. The Board acknowledges the Veteran's representative's Appellate Brief dated July 28, 2021. The Brief contained numerous links to medical literature. The VA examiner who provides an addendum opinion should also address the medical literature cited to by the Veteran's representative. Accordingly, service connection for OSA is remanded. The matters are REMANDED for the following action: 1. Obtain an addendum VA medical opinion to address the etiology of the Veteran's obstructive sleep apnea (OSA). If an opinion cannot be provided without a physical examination, one should be scheduled. The examiner should answer the following question: a) Is it at least as likely as not (50 percent or greater) that the Veteran's OSA either began during or was otherwise caused by his military service? Why or why not? b) Is it at least as likely as not (50 percent or greater) that the Veteran's OSA is etiologically related to his service, to include exposure to burn pits, chemicals (arsenic, barium, beryllium, cadmium, chromium, lead, sliver, stomium, and asbestos), and/or any other hazards and circumstances of his service? Why or why not? c) Is it at least as likely as not (50 percent or greater), that the Veteran's OSA was caused by any existing service-connected disabilities, to include PTSD? Why or why not? d) Is it at least as likely as not (50 percent or greater), that the Veteran's OSA was aggravated (made worse) by any of his service-connected disabilities, to include PTSD? Why or why not? If aggravation is found, the examiner should identify a baseline level of severity of the sleep apnea by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of the sleep apnea. The examiner's attention is directed toward the April 2020 VA medical opinion, which the Board has found to be inadequate because the examiner did not address any of the Board remand directives. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Fu, 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.