Citation Nr: A21017293 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 200515-84930 DATE: October 26, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, claimed as secondary to service-connected post-traumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran had active duty service from March 2009 to March 2012. The issues are on appeal under the Appeals Modernization Act (AMA) from a rating decision issued in April 2020. The Veteran submitted a notice of disagreement in May 2020 electing the direct review docket. Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claim, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. Entitlement to service connection for obstructive sleep apnea, claimed as secondary to service-connected PTSD, is remanded. Under AMA, the Board must remand to the Agency of Original Jurisdiction (AOJ) to correct pre-decisional duty to assist errors. 38 C.F.R. § 20.802 (a). Once the VA undertakes to provide a veteran with an examination, it has a duty to ensure it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In secondary service connection claims, a medical opinion is inadequate if it does not address both causation and aggravation of the nonservice-connected condition. El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013). The Veteran contends that service connection for obstructive sleep apnea is warranted as secondary to his already service-connected PTSD. The December 2017 VA examiner opined that the Veteran's sleep apnea was not caused by his service-connected PTSD. However, the examiner did not consider or opine as to whether the Veteran's sleep apnea was aggravated by PTSD. The March 2020 VA examiner did not conduct an in-person examination but opined that the Veteran had craniofacial and upper airway abnormalities. The basis for this opinion is not clear from the record. Additionally, the examiner did not consider the medical literature of record. For these reasons, the December 2017 and March 2020 VA opinions are inadequate and thus constitute pre-decisional duty to assist errors. Thus, a remand is necessary. Additionally, the Board notes that the May 2019 private opinion is insufficient. The examiner provided a positive nexus opinion but did not provide a rationale sufficiently specific to the Veteran. Also, a portion of the opinion was based on the examiner's statement that the Veteran was noncompliant with his continuous positive airway pressure therapy (CPAP) machine. However, this contradicts the Veteran's statements that he was compliant. See February 2017 VA treatment record; December 2017 VA examination. An opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458 (1993). The matters are REMANDED for the following action: Obtain an opinion from an appropriate clinician regarding whether the Veteran's obstructive sleep apnea is secondary to his service-connected PTSD. The examiner must provide the following opinions: (a.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that obstructive sleep apnea was caused by the Veteran's service-connected PTSD. (b.) Whether it is at least as likely as not (i.e., 50 percent or greater probability) that obstructive sleep apnea was aggravated by the Veteran's service-connected PTSD. The examiner must provide a complete rationale for his or her opinions, based on his or her clinical experience, medical expertise, and established medical principles as well as the relevant medical literature. Jennifer White Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mookim, Hope P. 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.