Citation Nr: 21064508
Decision Date: 10/20/21	Archive Date: 10/20/21

DOCKET NO. 17-37 148
DATE: October 20, 2021

REMANDED

The claim for service connection for sleep apnea is remanded.

The claim for service connection for erectile dysfunction is remanded.

REASONS FOR REMAND

The Veteran honorably served on active duty from March 1970 to March 1974. In a November 2014 rating decision, the Regional Office (RO) reopened, reconsidered, and denied the previously decided claim for service connection for sleep apnea, and denied service connection for erectile dysfunction. The Veteran appealed. In July 2021, the Veteran testified at a Board's hearing, a transcript of which is of record. At the hearing, the Veteran requested to hold the record open for 60 days, which had been granted and has elapsed. 

In seeking service connection, the Veteran maintains that his severe sleep apnea and erectile dysfunction, both documented in his VA treatment records, are likely secondary to his service-connected IHD and PTSD.  To that end, the Veteran submitted a study published in Journal of Clinical Sleep Medicine, in which the authors explore an association between sleep apnea and PTSD and ultimately conclude that the risks for developing sleep apnea in the veterans with PTSD are at much higher rates than in general population. The Veteran further stated under oath that he began experiencing erectile problems after his triple bypass heart surgery and after being placed on a new medication regimen. 

This evidence suggests that the Veteran's clinically diagnosed claimed disabilities may have been caused by his service-connected disabilities, but a more concrete determination requires medical expertise, and therefore triggers the VA's duty to provide a medical examination which has not been provided in this case. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4).

Accordingly, the matters are REMANDED for the following action:

1. Obtain an opinion as to the etiology of the Veteran's sleep apnea and erectile dysfunction. If an in-person examination is necessary to answer the Board's question, one must be provided. The examiner is asked to answer the following questions:

a)	Is it at least as likely as not (meaning probability of 50 percent or greater) that the Veteran's sleep apnea was proximately caused by, resulted from, or otherwise is etiologically related to any of his service-connected disabilities, to include PTSD and IHD? Why or why not?

b)	Is it at least as likely as not (meaning probability of 50 percent or greater) that the Veteran's erectile dysfunction was proximately caused by, resulted from, or otherwise is etiologically related to any of his service-connected disabilities, to include PTSD, IHD, and any associated treatment thereof? Why or why not?

In answering the Board's questions, the examiner should expressly discuss the medical treatise (marked "12/29/2017 Correspondence") as well as expressly address the Veteran's contentions.

c)	Is it at least as likely as not (50 percent or greater probability) that the Veteran's erectile dysfunction was aggravated (made worse) by any of his service-connected disabilities, to include PTSD, IHD, and any associated treatment thereof? Why or why not?

d)	Is it at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was aggravated (made worse) by any of his service-connected disabilities, to include PTSD, IHD, and any associated treatment thereof? Why or why not? 

 

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Alex Bardin, 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.