Citation Nr: 21064437 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 15-41 418 DATE: October 20, 2021 REMANDED The issue of entitlement to service connection for a sleep disorder, to include sleep apnea, secondary to service-connected occipital headaches is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1966 to October 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. Jurisdiction was subsequently transferred to the RO in Columbia, South Carolina. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in October 2018. The transcript of the hearing has been associated with the claims file. This matter was previously before the Board at which times it was remanded for further development. Entitlement to service connection for a sleep disorder, to include sleep apnea, secondary to service-connected occipital headaches is remanded. The Veteran contends that he has a sleep disorder secondary to his service-connected occipital headaches. In this regard, the evidence of record includes an August 2021 VA Sleep Apnea examination report in which the examiner opined that the claimed condition was less likely than not proximately due to or the result of a service-connected condition and less likely than not aggravated beyond its natural progression by a service-connected condition. The examiner reasoned that there is no pathophysiological correlation of occipital headaches and REM sleep disorder. Based on this, the examiner determined that a nexus could not be established between the current REM sleep disorder and the Veteran's occipital headaches. The Board finds the August 2021 VA opinion inadequate to decide the Veteran's claim for service connection for a sleep disorder. The August 2021 VA examiner provided a cursory rationale in support of his negative opinion. Medical opinions must support their conclusions with a thoroughly articulated medical analysis or rationale the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Therefore, the Board finds that a remand is necessary in order to obtain a more comprehensive rationale. See Barr v. Nicholson, 21 Vet. App. 303, 311(2007) (once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Return the record to the August 2021 VA examiner. The record and a copy of this Remand must be made available to the examiner. If the examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. (a.) Is it at least as likely as not that the Veteran has a sleep disorder that was caused or aggravated (worsened beyond normal progression) by his service-connected occipital headaches? The examiner is asked to address both causation and aggravation. The examiner is asked to specifically discuss the Veteran's October 2018 Board testimony regarding difficulty sleeping related to his service-connected occipital headaches. If the examiner concludes that there is no pathophysiological correlation of occipital headaches and REM sleep disorder, please specifically discuss why that is so, and explain why such means that the Veteran's sleep disorder cannot be related to his headaches. (b.) Please note that the Veteran is service connected for occipital headaches. (c.) If the examiner finds that the Veteran's sleep disorder has been worsened beyond normal progression (aggravated) by the Veteran's service-connected occipital headaches, the examiner should attempt to quantify the degree of aggravation beyond the baseline level that is attributed to the service-connected disability. All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.