Citation Nr: 21063142 Decision Date: 10/13/21 Archive Date: 10/13/21 DOCKET NO. 17-44 391 DATE: October 13, 2021 REMANDED Entitlement to service connection for a sleep disorder, to include sleep apnea, is remanded. REASONS FOR REMAND The Veteran had active duty service with the U.S. Army from January 1984 to January 1987 and from October 1990 to May 1991. He died in January 2018. The appellant is his surviving spouse; she has been recognized as a substituted claimant. 38 U.S.C. § 5121A; 38C.F.R. §3.1010. The claimant is considered to be pursuing the Veteran's outstanding claims to completion in his stead and on his behalf. Unlike a claim for accrued benefits, the record remains open as it would be for the Veteran. At the time of the Veteran's death, there were outstanding claims awaiting adjudication. In June 2020 the Board granted service connection for bilateral pes planus; denied the reopening of the claim of service connection for pseudofolliculitis barbae; denied service connection for a mass on the aortic valve and a disability rating in excess of 30 percent for posttraumatic stress disorder (PTSD); and remanded the Veteran's claim of service connection for sleep apnea. This case comes before the Board of Veteran's Appeals (Board) on appeal from a November 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board acknowledges that the Veteran was previously denied service connection for sleep a sleep disorder and implicitly denied service connection for sleep apnea on a direct basis by the Board in a November 2009 decision. Furthermore, the Board acknowledges that after the filing for a reopening and a new claim for sleep disturbance and sleep apnea, respectively, he only perfected the appeal of sleep apnea to the Board. See August 2017 VA Form 9. However, under See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009), the Board is including consideration of all the related conditions reasonably raised by the record. To the extent required, the opinion below is deemed to be new and material evidence under 38 C.F.R. § 3.156 with respect to any finally denied aspect of the claim. A VA addendum opinion for sleep apnea was submitted in September 2020. The opinion related that "self-medication with alcohol is found among patients with PTSD, and alcohol affects sleep quality and stages of sleep." The Board notes that the Veteran is service-connected for PTSD; however, the Board is unclear on whether the Veteran's sleep disturbance is a separate and distinct diagnosis from the diagnosis of PTSD and any other diagnosed psychiatric condition. See January 2017 PTSD VA examination for more diagnoses. This matter should be addressed on remand. Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007). The matters are REMANDED for the following action: Obtain an addendum opinion from a VA examiner addressing the nature and etiology of the Veteran's sleep disorder. (a.) Please diagnose all disorders productive of sleep disturbances. Please specifically address the severe major depression noted in the January 2017 VA examination. (b.) For each disorder diagnosed in sub-part (a), please opine as to whether it is at least as likely as not (50 percent or greater probability) proximately due to PTSD, to include self-medication with alcohol. (c.) For each disorder diagnosed in sub-part (a), please opine as to whether it at least as likely as not (50 percent or greater probability) has been aggravated (worsened beyond natural progression) by PTSD, to include self-medication with alcohol. Please discuss the September 2020 opinion stating alcohol has effects on sleep. A complete rationale must be provided. If an opinion cannot be reached without resorting to speculation, the examiner must explain why. ERIC S. LEBOFF Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. J. Rogers, 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.