Citation Nr: 21062303
Decision Date: 10/07/21	Archive Date: 10/06/21

DOCKET NO. 15-10 862
DATE: October 7, 2021

REMANDED

Entitlement to service connection for sleep apnea is remanded.

REASONS FOR REMAND

The Veteran had active service in the Army from November 1971 to November 1974.  

The appeal originates from a July 2014 decision of a Department of Veterans Affairs (VA) Regional Office.

The Veteran appeared for a hearing before the undersigned in November 2015. The matter was previously remanded for additional development in June 2018, July 2020, and February 2021.

The Veteran contends that his diagnosed obstructive sleep apnea is related to service or secondary to service-connected posttraumatic stress disorder (PTSD) or diabetes mellitus.  As discussed in the Remands, there remained conflicting medical evidence as to the relationship between the Veteran's sleep apnea and PTSD.  The February 2021 Remand directed that a new opinion be obtained regarding direct and secondary service connection.  

 

While an opinion was obtained in March 2021, it does not appear to fully address the etiology of sleep apnea.  The examiner rendered a negative nexus opinion for direct service connection seemingly based only on the absence of evidence in the service treatment records.  The examiner found no evidence that sleep apnea was aggravated by any service-connected disability. The examiner did not appear to offer any elaboration/rationale for this conclusion. Moreover, contrary to the direction of the February 2021 Remand, the examiner did not address the evidence specified.  

The matter is REMANDED for the following action:

Request an etiology opinion from the November 2019 sleep apnea examiner.  If that examiner is unavailable, provide the Veteran's file to an examiner who has not previously provided an opinion.  The examiner is asked to provide a new opinion based on an independent review of the file.  The examiner should address the following:

1. Is it at least as likely as not that sleep apnea had its onset in or is otherwise etiologically related to active service?  The examiner should comment on the lay statements that the Veteran developed symptoms of sleep apnea in service.

2. Is it at least as likely as not that sleep apnea was proximately caused by any service-connected disability?  The examiner should address the medical literature cited in November 2015 correspondence and July 2019 private opinion (received in October 2020).

3. Is it at least as likely as not that sleep apnea underwent an incremental increase in disability, regardless of its permanence, by any service-connected disability? The examiner should again address the medical literature cited in November 2015 correspondence and July 2019 private opinion (received in October 2020). 

 

MICHAEL A. HERMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Alhinnawi

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.