Citation Nr: 21064100 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-47 708 DATE: October 19, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from June 2002 to July 2014. In March 2019, the Board remanded the above issue to obtain a VA opinion on the etiology of the Veteran's sleep apnea. A VA opinion was subsequently rendered in March 2019. The issue has since returned to the Board for appellate review. 1. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected PTSD, is remanded. The Veteran contends that his sleep apnea is directly related to his military service. The Veteran specifically reported that he had symptoms of sleep apnea, to include snoring, during his military service. Alternatively, he contends that his sleep apnea is secondary to his PTSD. At the outset, the Board notes that the Veteran has a 2017 diagnosis of obstructive sleep apnea. See March 2019 VA examination. The Board notes that, in February 2017, the VA examiner opined that obstructive sleep apnea is related to "post service weight gain/obesity" rather than PTSD, raising the issue of whether the Veteran's weight gain is related to his PTSD and sleep apnea. Although service connection is not allowed for obesity on its own, obesity could act as an "intermediate step" to establish service connection for sleep apnea as secondary to an already service-connected disability under certain circumstances. See VAOPGCPREC 1-2017. In March 2019, the VA examiner opined that is less likely than not that the Veteran's obesity is related to his service. There is no indication that any condition was diagnosed while he was in the military that would have caused his obesity such as a thyroid disorder or hormonal imbalance. The significant change in his weight occurred after he left the military. There was no diagnosed obstructive sleep apnea while in the military and therefore his weight gain while in the military would not have been able to aggravate the condition not yet diagnosed. Once he separated from the military and gained weight he was diagnosed with obstructive sleep apnea. The weight gain after he left the military was likely the major contributing factor. The March 2019 VA examiner also opined that it was less likely than not that the Veteran's obesity is caused by or aggravated by his service-connected PTSD. The examiner reasoned that there is no indication that any condition was diagnosed while he was in the military that would have caused his obesity such as a thyroid disorder or hormonal imbalance. The examiner noted that the significant change in his weight occurred after he left the military. There was no diagnosed obstructive sleep apnea while in the military and, therefore, his weight gain while in the military would not have been able to aggravate the condition not yet diagnosed. The examiner noted that there was no evidence of sleep apnea in the military, and his weight gain fluctuated in the military. However, there was no evidence to support that weight gain caused sleep apnea, and, therefore, there is no aggravation either. The Board finds the March 2019 opinion regarding the Veteran's weight gain inadequate. The March 2019 VA examiner provided an explanation regarding the Veteran's weight gain post service and his sleep apnea. The examiner relied, in part, on the fact that significant weight gain occurred after his military service, not during his military service. However, the examiner did not provide a rationale that discussed obesity as an "intermediate step" between sleep apnea and his service-connected PTSD. Specifically, the VA examiner did not provide a rationale to explain whether the Veteran's obesity is linked to his psychiatric disorder. The March 2019 VA examiner noted the Veteran's weight gain, but did not discuss his psychiatric symptoms or the impact those symptoms had on his weight gain. Therefore, while the Board regrets the additional delay, a remand is necessary to obtain another VA opinion concerning the etiology of the Veteran's sleep apnea. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's sleep apnea is related to obesity caused by his service-connected disabilities. The examiner must review the claims file. a. Initially, the examiner is asked to provide an opinion as to whether the Veteran's service-connected PTSD, and/or other service-connected conditions, caused him to become obese. b. If this opinion is positive, the examiner is asked to address the remaining directives below. i. Whether obesity was a substantial factor in causing the Veteran's sleep apnea. ii. Whether the Veteran's sleep apnea would not have occurred but for obesity. 2. Then, readjudicate the claim. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. E. Grossman, 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.