Citation Nr: 21065057 Decision Date: 10/23/21 Archive Date: 10/23/21 DOCKET NO. 17-00 925 DATE: October 23, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1968 to February 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision. In July 2021, the Veteran testified before the undersigned Veterans Law Judge at a video virtual hearing. A transcript of the hearing has been associated with the file. Entitlement to service connection for sleep apnea is remanded. The Veteran contends that he is unable to adequately treat his obstructive sleep apnea due to his service-connected residuals of a right orbital floor fracture with open reduction and insertion of Supramid prosthesis. See NOD received 9/29/2015 at page 2. Further, he stated in correspondence, that he is unable to use a CPAP machine to treat his sleep apnea because of the sinus surgery. See Correspondence received 6/15/2021 at page 2; see also 6/15/2021 Medical Treatment Record Non-Gov't Facility, at 3. The record shows that the Veteran is currently service-connected for chronic sinusitis with residuals, right orbital floor fracture with open reduction and insertion of Supramid prosthesis and the residuals of such. An October 2014 VA medical opinion found it was less likely than not that the Veteran's sleep apnea was proximately due to, or the result of, or aggravated by his residuals. See C&P Exam received 10/16/2014 at page 5. The October 2014 VA examiner reasoned that his sleep apnea was instead due to his risk factors, namely, his age, male sex, obesity, etc. Id. As to aggravation, the examiner made a conclusionary statement that his sleep apnea was not aggravated by his service-connected disabilities. The Veteran's primary contention is that his sleep apnea is aggravated by his residuals. Specifically, that his inability to treat his apnea with a CPAP machine leads to a worsening of the condition. Since the opinion on aggravation is not complete, the Board finds that a remand for a VA examination and a new medical opinion is necessary. Additionally, on remand, the VA examiner can consider additional medical evidence that was submitted subsequent to the October 2014 VA medical opinion on file. This matter is REMANDED for the following action: Schedule the Veteran for a VA examination for his sleep apnea. The examiner must review the claims file. The examiner is asked to provide a response to the following: (a) Is the Veteran's sleep apnea at least as likely as not proximately due to his service-connected chronic sinusitis and residuals from his related surgery? (b) Is the Veteran's sleep apnea at least as likely as not aggravated, i.e., worsened beyond its natural progression, by his service-connected sinus residuals? In offering an opinion, the examiner should consider medical and lay evidence dated prior to or since filing the claim, including the Veteran's July 2021 Board hearing testimony and relevant medical records, such as the one from L.K.G., from June 2021 (see 6/15/2021 Medical Treatment Record Non-Gov't Facility, at 3). A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). Paul Sorisio Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Dixon, 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.