Citation Nr: 21062540 Decision Date: 10/08/21 Archive Date: 10/07/21 DOCKET NO. 19-03 592 DATE: October 8, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected unspecified trauma- and stressor-related disorder with situational phobia, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1969 to January 1971, to include service in Republic of Vietnam from January 1970 to October 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in May 2018 by a Regional Office of the Department of Veterans Affairs (VA). In June 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the undersigned held the record open for 30 days for the submission of additional evidence, which was received later that month. Entitlement to service connection for OSA, to include as secondary to service-connected unspecified trauma- and stressor-related disorder with situational phobia. At his Board hearing and in documents of record, the Veteran contends that his current OSA, which was diagnosed by sleep study in November 2017, is directly related to service as a result of being sleep deprived while remaining on red alert while in Vietnam or, in the alternative, secondary to his service-connected unspecified trauma- and stressor-related disorder with situational phobia (which had previously been characterized as posttraumatic stress disorder (PTSD)). In this regard, both he and his spouse report that he had difficulty sleeping since service, one of the phobias related to his psychiatric disorder centers around being in the dark when he is falling asleep, and such disorder is manifested by sleep disturbances, to include difficulty falling and stay asleep. The Veteran has also submitted several articles summarizing the results of studies that concluded there is a clinical correlation between PTSD and OSA. However, when rendering the December 2018 opinion determining that the Veteran's OSA is neither caused nor aggravated by his service-connected psychiatric disorder, the VA clinician cited the physiological factors causing OSA, as well as a litany of risk factors for developing such disorder, and concluded that medical literature does not show any pathophysiologic evidence to link PTSD or any other psychiatric disorder as a proximate cause or aggravating factor that would affect the airway obstruction that causes OSA. However, when determining that no such medical literature exists to support such a correlation, the clinician did not reference or discuss the two articles then of record addressing such a correlation, or otherwise explain why these articles did not constitute medical literature suggesting such a correlation. Further, since this medical opinion was rendered in December 2018, the Veteran has submitted five more articles discussing the comorbidity of psychiatric disorders and OSA and how psychiatric symptoms interfere with CPAP efficacy and compliance in the treatment of OSA. Accordingly, a remand is necessary in order to obtain an addendum opinion that addresses such relevant medical literature. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Furthermore, as no opinion addressing the direct aspect of the Veteran's claim has been obtained, such should also be accomplished on remand. The matter is REMANDED for the following action: Forward the record to an appropriate VA clinician for a medical opinion addressing the etiology of the Veteran's OSA. The record, to include a copy of this Remand, must be made available to the clinician. The need for an examination of the Veteran is left to the discretion of the clinician selected to write the opinion. Following a review of the record, the examiner should address the following inquiries: (A) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's OSA had its onset in, or is otherwise related to, his military service, to include as a result of being sleep deprived while remaining on red alert while in Vietnam? In offering such opinion, the examiner should consider the Veteran's and his spouse's reports that he had difficulty sleeping since service. (B) Is it at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran's OSA is caused or aggravated by his unspecified trauma- and stressor-related disorder with situational phobia (previously characterized as PTSD)? For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner should consider and comment on the clinical significance of the seven articles submitted by the Veteran addressing the comorbidly of OSA and psychiatric disorders; data indicating that having a psychiatric disorder is a risk factor for developing OSA, and evidence that psychiatric symptoms interfere with the efficacy and compliance of CPAP therapy. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. Northcutt, 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.