Citation Nr: 21066509 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 18-18 468 DATE: November 1, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from October 1965 to August 1972. This case comes before the Board of Veterans' Appeals (Board) on an appeal from a November 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office. The Veteran testified before the undersigned at a Board videoconference hearing in July 2021, and a copy of the hearing transcript has been obtained and associated with the record. 1. Entitlement to service connection for sleep apnea is remanded. The Veteran appeals the denial of service connection for sleep apnea. The Veteran contends that his sleep apnea is due to service. Specifically, he claims that the fractured sleep from shift work and stress from being in a war zone during service caused his sleep apnea. Also, he claims that his sleep apnea is secondary to his service-connected persistent depressive disorder. In his July 2021 Board hearing, the Veteran testified he was diagnosed with obstructive sleep apnea in May 2011, and that he has used a continuous positive airway pressure machine (CPAP) since June 2000. The Veteran also discussed how during service he snored loudly and felt tired often. His wife even provided a buddy statement describing the Veteran's loud snoring and gasping for air during his sleep while he was still in service. Also, during the hearing, the Veteran's representative discussed an article from the Journal of Clinical Sleep Medicine that found people with mental conditions like depression and anxiety were more likely to develop sleep apnea. Accordingly, the Board finds that the low threshold of the McLendon standard has been met in this instance, and the Veteran should be afforded a VA examination to determine the nature and etiology of his sleep apnea. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). Therefore, a remand is necessary to obtain an opinion as to the nature and etiology of the Veteran's sleep apnea, and as to whether his sleep apnea is proximately due to or aggravated by his service-connected persistent depressive disorder. 2. Entitlement to service connection for hypertension is remanded. The Veteran appeals the denial of service connection for hypertension. The Veteran claims he did not have hypertension prior to his service in the military and his exposure to herbicide agents. Also, through his testimony at his Board hearing in July 2021, he claims that his hypertension is secondary to his service-connected persistent depressive disorder. At his Board hearing, the Veteran testified that he was diagnosed with hypertension in May 2011, and that his exposure to Agent Orange during his service in Vietnam caused his hypertension. He referenced a study conducted by the National Academies of Science, Engineering, and Medicine concerning Agent Orange exposure and the association with hypertension. He also referenced a study from the Journal of Hypertension done in May 2011 that linked hypertension to people with mental health conditions. The Veteran's medical records show he is being treated for high blood pressure. Therefore, the Board finds that the low threshold of the McLendon standard has been met in this instance, and the Veteran should be afforded a VA examination to determine the nature and etiology of his hypertension. See McLendon, 20 Vet. App. 79, 81 (2006). The examiner should provide an opinion as to the nature and etiology of the Veteran's hypertension, and as to whether the Veteran's exposure to herbicide agents during his service in Vietnam caused his disability. Also, the examiner should opine as to whether the Veteran's hypertension is proximately due to or aggravated by his service-connected persistent depressive disorder. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's sleep apnea. The examiner is asked to provide a response to the following: Whether it is at least as likely as not (a 50 percent or better probability) that such had onset in, or is otherwise related to, the Veteran's period of active duty. Whether it is at least as likely as not (a 50 percent or better probability) that the Veteran's sleep apnea is at least as likely as not (1) proximately due to, or (2) aggravated beyond its natural progression by his service-connected persistent depressive disorder. Aggravation means an increase in disability any additional impairment of earning capacity - of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's hypertension. The examiner is asked to provide a response to the following: Whether it is at least as likely as not (a 50 percent or better probability) that the Veteran's hypertension was incurred in or otherwise related to his active duty. The examiner must consider the Veteran's statements concerning exposure to herbicide agents during his service in Vietnam. Whether it is at least as likely as not (a 50 percent or better probability) that the Veteran's hypertension is at least as likely as not (1) proximately due to, or (2) aggravated beyond its natural progression by his service-connected persistent depressive disorder. Aggravation means an increase in disability any additional impairment of earning capacity - of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. All examiners must review the entire claims folders, including a copy of this remand. A complete rationale must be provided for all opinions expressed. If the requested opinion cannot be provided without resort to (Continued on the next page) speculation, the examiner should so state and explain why an opinion would be speculative. J. B. FREEMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Doerfler, 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.