Citation Nr: 21065369 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 17-35 990 DATE: October 26, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had honorable active service with the United States Army from January 1986 to January 2008. This matter is before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In February 2019, the Board remanded the Veteran's claim to obtain potentially missing private treatment records. These records were obtained and in June 2020 the RO completed a Supplemental Statement of the Case (SSOC). Afterward the case was certified to be returned to the Board. Then in July 2021, the Veteran underwent a new sleep apnea VA examination. The Board noted that this evidence was received after certification to the Board; however, since the claim is being remanded, the evidence will be reviewed by the RO before the claim is finally adjudicated. Entitlement to sleep apnea is remanded. Although further delay is regrettable, a remand is necessary for an adequate VA opinion. When an opinion does not express the right degree of certainty, does not provide a rationale, is conclusory, does not consider all of the relevant evidence of record including lay statements, or does not consider all raised theories of entitlement then the examination is inadequate. Steff v. Nicholson, 21 Vet. App. 120 (2007); Bloom v. West, 12 Vet. App. 185, 187 (1999); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Combee v. Brown, 34 F.3rd1039, 1043-44 (Fed. Cir. 1994). The Veteran asserts that her sleep apnea is secondary to her service-connected hypertension. While the record contains two opinions, the Board finds that both VA opinions are inadequate. In particular, the July 2021 VA examiner did not opine as to whether the Veteran's sleep apnea was at least as likely as not aggravated by the service-connected hypertension. The opinion also failed to provide an adequate rationale. The June 2017, VA opinion did not consider all of the relevant evidence of record. Thus, the July 2021 and June 2017 VA medical opinions are inadequate for adjudication purposes. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (holding that when the VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (holding that an opinion for secondary service connection is inadequate when it does not address or rule out the possibility that the service-connected impairment aggravated to some degree the claimant's non service-connected impairment). Thus, a remand is needed to obtain an adequate VA medical opinion. The matters are REMANDED for the following action: 1. Update all VA and private treatment records as deemed necessary. 2. After completing the above development, request a VA medical opinion with a medical expert with the appropriate training and expertise to determine the nature and etiology of the Veteran's sleep apnea. Following review of the claims file, the examiner should answer the following questions: (a.) is it at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea was either: 1. caused by the Veteran's service-connected hypertension, OR; 2. aggravated by (i.e., worsened beyond the normal progression of the disease) the Veteran's service-connected hypertension? In addressing whether the Veteran's service-connected hypertension, was a source of aggravation of the Veteran's sleep apnea, the examiner must attempt to establish a baseline level of severity of the sleep apnea prior to aggravation by the service-connected disability, if any can be determined. 3. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 4. If any benefit sought on appeal is not granted, the Veteran and her representative should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is returned to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Associate Counsel, C. Parnell 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.