Citation Nr: 21065674 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 18-00 551 DATE: October 27, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as due to service-connected unspecified depressive disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1974 to November 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran presented testimony at a video conference hearing before the undersigned Veterans Law Judge. A transcript is on record. In early March 2020, the Board remanded the claim to afford the Veteran a VA examination on the etiology of his sleep apnea as possibly due to his service-connected hepatitis C and/or its treatment. This examination was accomplished mid-March 2020. Entitlement to service connection for obstructive sleep apnea, to include as due to service-connected unspecified depressive disorder, is remanded. When the Veteran first filed for service connection for sleep apnea, he claimed it had been caused or aggravated by his service-connected hepatitis C or its treatment. The Veteran was provided a VA examination in March 2020 to answer this question. While the March 2020 examiner supplied thorough and detailed rationales as to why the Veteran's sleep apnea is not caused or aggravated by his hepatitis C or its treatment, the record now indicates the condition may be caused or aggravated by his recently service-connected unspecified depressive disorder. Since the Board's March 2020 remand, the Veteran has been service-connected for depressive disorder. An initial mental health encounter from January 2021 notes a possible relation between his depression, anxiety, and sleeping problems; and an addendum notes the Veteran reported concern about difficulty sleeping, frequently waking up throughout the night feeling short of breath and gasping for air, symptoms which the attending psychologist found were concomitanti.e., accompanying or associatedwith his mood. Further, a July 2021 mental health examiner included in a written section gathering psychiatric symptoms "sleep disorder diagnosis: untreated sleep apnea" and in the section listing symptoms applying to the Veteran's depressive disorder "chronic sleep impairment." As the evidence stands, it is unclear as to the relationship between the Veteran's sleep apnea and service-connected unspecific depressive disorder. As competent medical evidence indicates the Veteran's sleep apnea may be aggravated by his service-connected unspecified depressive disorder, a remand for an examination to investigate this link is warranted. See 38 U.S.C. § 5103A (d)(2); 38 C.F.R. § 3.159 (c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following actions: 1. Schedule the Veteran for a VA examination to determine whether his obstructive sleep apnea is etiologically related to his service-connected unspecified depressive disorder. The claims file and a copy of this remand must be made available to the examiner and the examiner should note a review of such in the examination report. After a thorough review of the claims file and examination of the Veteran, the examiner is asked to opine on the following: Is it at least as likely as not (50 percent or greater probability) that the Veteran's currently diagnosed obstructive sleep apnea has been caused or aggravated by his service-connected unspecified depressive disorder? Aggravation does not require that there be "permanent" worsening of the nonservice connected disability. The examiner is reminded causation and aggravation are independent concept, and should have separate findings and rationales. In rendering this opinion, the examiner is asked to comment on the relationship between the two disabilities noted in the Veteran's January 2021 initial mental health assessment and his July 2021 VA mental health examination report. A complete rationale must be provided for any opinion expressed. A complete rationale contains data, clear conclusions, and a reasoned medical explanation connecting the two. (Continued on the next page) 2. Then, readjudicate the claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.A. Infante, 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.