Citation Nr: 21067376 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 16-12 909 DATE: November 4, 2021 REMANDED Service connection for sleep apnea, including as secondary to service-connected posttraumatic stress disorder (PTSD) with major depressive disorder (MDD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from August 2000 to December 2000 and from January 2005 to July 2006. This appeal arises from a July 2015 rating decision, denying service connection for sleep apnea. The Veteran testified at a Board videoconference hearing in March 2019, before the undersigned Veterans Law Judge (VLJ). A transcript is of record. In October 2019, the Board remanded the sleep apnea issue to the AOJ for additional development and consideration. Then, in June 2020, the Board denied the appeal for service connection for sleep apnea. On appeal, in a June 2021 Order, the U.S. Court of Appeals for Veterans Claims (CAVC) granted a May 2021 Joint Motion for Remand (JMR) that vacated the Board's prior June 2020 decision, and remanded the matter to the Board. 1. Sleep apnea The Veteran contends his sleep apnea began in service due to environmental hazards in Southwest Asia, such as burning trash, human feces and sandstorm inhalation. See Board hearing transcript. His DD Form 214 shows verified service in Kuwait and Iraq from January 2005 to July 2006. He has also submitted testimony and buddy statements that he had in-service symptoms of loud snoring and cessation of breathing while sleeping. See Board hearing transcript; November 2016 buddy statement by M.T.; and April 2019 buddy statement by C.D. The Veteran has a current diagnosis of obstructive sleep apnea (OSA) following an April 2015 VA treatment sleep study and a November 2020 VA sleep apnea examination. In October 2019, the Board remanded the claim for the AOJ to provide a VA examination and medical nexus opinion on the etiology of the Veteran's diagnosed obstructive sleep apnea (OSA), including consideration of the Veteran's lay statements. A remand by the Board confers on a Veteran the right to substantial compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008). Per the JMR, a February 2020 VA negative nexus opinion was inadequate, as it did not consider the Veteran's lay statements asserting in-service environmental hazard exposure. When VA undertakes to examine a Veteran, VA is obligated to ensure that that examination is adequate. See Barr v. Nicholson, 21. Vet. App. 303 (2007). Inadequate medical examinations include examinations that contain only data and conclusions, do not provide an etiological opinion, are not based upon a review of medical records, or provide unsupported conclusions. Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Moreover, a December 2020 VA examiner provided a negative opinion on the possibility of secondary service connection for his sleep apnea, noting that there is no direct correlation in this case between his sleep apnea and his service-connected PTSD/MDD. However, the opinion did not address the possibility that his psychiatric disability aggravated his sleep apnea, so further medical comment is needed. The Board finds it necessary to remand for the AOJ to obtain another VA medical opinion on the etiology of the Veteran's OSA, with express consideration of the Veteran's lay statements, particularly the contention of exposure to environmental hazards during service, as well as the possibility of secondary service-connection. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran's obstructive sleep apnea. (A) The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater) that any diagnosed obstructive sleep apnea is related to service. In providing such opinion, the examiner should consider the competent lay statements of a history of sleep problems during and since service, from the Veteran, his wife, and buddy statements. The examiner must reconcile the Veteran's assertion of exposure to environmental hazards in Southwest Asia, such as burning trash, human feces and sandstorm inhalation. (B) Whether it is at least as likely as not that any diagnosed obstructive sleep apnea was caused and/or aggravated by his service-connected PTSD/MDD. (Continued on the next page) A complete rationale should be provided for all opinions rendered C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Chatterjee, B. 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.