Citation Nr: 21066078
Decision Date: 10/28/21	Archive Date: 10/28/21

DOCKET NO. 19-36 111
DATE: October 28, 2021

REMANDED

Entitlement to service connection for sleep apnea, to include as due to an acquired psychiatric disorder, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from November 1984 to June 1992.

This matter returns to the Board of Veterans' Appeals (Board) following the issuance of a May 2021 Board remand which directed the RO to complete additional development.  

1. Entitlement to service connection for sleep apnea, to include as due to an acquired psychiatric disorder, is remanded.

The Veteran is seeking service connection for sleep apnea.  He asserts that his sleep apnea began during his time in service and/or is secondary to his service-connected acquired psychiatric disorder, diagnosed as posttraumatic stress disorder (PTSD). 

This matter was previously remanded so that an addendum opinion could be obtained to evaluate the nature and etiology of the Veteran's sleep apnea.  The Veteran was afforded an examination in August 2021.  The examiner opined that the Veteran's sleep apnea was not caused or aggravated by his PTSD, including via obesity caused by PTSD.  Specifically, the examiner noted that as a mental disorder, PTSD does not affect the structural pathology of sleep apnea, namely the airway narrowing due to muscles at the back of the throat.  The examiner did, however, note that the Veteran's obesity was likely the primary cause of his sleep apnea.  Further, the examiner noted that while the incidence of obesity and PTSD were on the rise, that PTSD alone does not cause obesity, which is more likely due to overconsumption of calories.  

The Board finds this opinion to be inadequate as far as the secondary service connection section is concerned.  The examiner did not provide any elaboration as to why PTSD may not alone lead to obesity, conceding some effect from the disorder on the development of obesity.  Furthermore, the examiner did not discuss the fact that the Veteran is prescribed two medications for his PTSD: escitalopram oxalate and trazodone.  Both of these medications can cause weight gain as a side effect and may have an impact on the Veteran's weight.  Finally, psychiatric disorders such as PTSD commonly have an effect on a person's brain chemistry which may affect a person's weight or other physical attributes. 

Additionally, the Veteran is service connected for both left knee and low back disabilities.  An opinion on the impact that these disorders may have on the Veteran's obesity and consequently, his sleep apnea, should also be obtained. 

While the Board regrets a further delay of the Veteran's claim, a remand is necessary so that a proper VA examination opinion can be obtained. 

The matters are REMANDED for the following action:

1. The RO should invite the Veteran to submit any evidence in support of his claim. 

2. Obtain an addendum opinion, from an appropriate clinician, to determine the nature, extent, onset, and etiology of the Veteran's sleep apnea. 

The complete claims file should be made available to the examiner.  

The examiner is asked to address the following questions:

a.	Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's obstructive sleep apnea is caused or aggravated by his service-connected PTSD, including by any prescribed medications and/or neurochemical causes which may have caused him to gain weight. 

b.	Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's obstructive sleep apnea is caused or aggravated by his service-connected left knee and/or low back disabilities, including by any prescribed medications that may have cause him to gain weight. 

All opinions should be accompanied by adequate reasons and bases. If the examiner cannot provide the requested opinion without resorting to mere speculation, they should provide a complete explanation stating why this is so.

 

In so doing, the examiner should explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that they have exhausted the limits of current medical knowledge in providing an answer to that particular question(s).

 

 

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Q. Hernan, Attorney Advisor