Citation Nr: 21067433 Decision Date: 11/04/21 Archive Date: 11/04/21 DOCKET NO. 17-39 053 DATE: November 4, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. Entitlement to service connection for hypertension (claimed as high blood pressure), to include as secondary to sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from March 2007 to December 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in New York, New York. In March 2019, the Board remanded the appeal for further development. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claims, so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159 (c). 1. Entitlement to service connection for sleep apnea is remanded. The Veteran has specifically claimed entitlement to service connection for obstructive sleep apnea, and the medical evidence of record shows a current diagnosis. In his May 2015 claim, the Veteran sought service connection for obstructive "sleep apnea-OIF (Operation Iraqi Freedom)." In this case, the Veteran is service connected for PTSD due to combat operations in Iraq. When a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Thus, the Board has broadly construed this claim as one of entitlement to service-connection for obstructive sleep apnea, to include as secondary to service-connected disabilities. The Board finds that additional development is necessary prior to adjudicating the claim. Specifically, remand is necessary for an adequate nexus opinion. The Veteran was afforded a VA examination for his sleep apnea in January 2020, and the examiner provided a negative opinion. The examiner opined that the Veteran's obstructive sleep apnea was not due to environmental exposure in Southwest Asia and was not due to an undiagnosed multi-symptom illness. However, the examiner did not provide an opinion on direct service connection, nor address the lay evidence of record indicating in-service symptomology of snoring and sleep disturbances. Additionally, subsequent to the January 2020 VA examination, the RO granted service connection for PTSD. The evidence of record indicates that the Veteran is diagnosed with PTSD, to include symptoms of insomnia and sleep disturbances. The Board finds that this evidence raises the possibility of secondary service connection, to include on the basis of aggravation. As such, remand is also required for an adequate medical opinion regarding direct and secondary service connection. 2. Entitlement to service connection for hypertension (claimed as high blood pressure), to include as secondary to sleep apnea, is remanded. The Veteran has specifically claimed entitlement to service connection for hypertension and the medical evidence of record shows a current diagnosis. In his May 2015 claim, the Veteran sought service connection for hypertension-OIF (Operation Iraqi Freedom)." In this case, the Veteran is service connected for PTSD due to combat operations in Iraq. When a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Thus, the Board has broadly construed this claim as one of entitlement to service-connection for hypertension, to include as secondary to service-connected disabilities. The Board finds that additional development is necessary prior to adjudicating the claim. Specifically, remand is necessary for an adequate nexus opinion. The Veteran was afforded a VA examination for his hypertension in January 2020, and the examiner provided a negative opinion. The examiner opined that the Veteran's hypertension was not causally or etiologically related to the Veteran's period of active service and did not manifest within one year of his separation from service. Additionally, the examiner opined that the Veteran's hypertension was not due to or aggravated by his obstructive sleep apnea. However, the examiner did not provide an opinion on secondary service connection. Subsequent to the January 2020 VA examination, the RO granted service connection for PTSD. The evidence of record indicates that the Veteran is diagnosed with PTSD, with anxiety and chronic sleep disturbances. The Board finds that this evidence raises the possibility of secondary service connection, to include on the basis of aggravation. As such, remand is also required for an adequate medical opinion regarding secondary service connection. Finally, because a decision on the remanded issue of entitlement to service connection for obstructive sleep apnea could significantly impact a decision on the issue of entitlement to service connection for hypertension, to include as secondary to his obstructive sleep apnea, the issues are inextricably intertwined. A remand of the claim for entitlement to service connection for hypertension is required. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA and private treatment records pertinent to the Veteran's claims. 2. Refer the case to an appropriate VA examiner (s) for an addendum opinion to determine the nature and etiology of the Veteran's obstructive sleep apnea. The claims folder and this remand must be made available to the examiner for review, and the examination report must reflect that such a review was undertaken. After a complete review of the record, the examiner must provide an opinion regarding the nature and etiology of the Veteran's obstructive sleep apnea. In rendering this opinion, the examiner must address each of the following: 1. The examiner must include an opinion on whether it is as likely as not (50 percent or more probability) that the Veteran's obstructive sleep apnea is related to service. 2. The examiner must also opine whether it is at least as likely as not (50 percent or more probability) that the Veteran's disability is caused or aggravated by the Veteran's service-connected PTSD. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. Refer the case to an appropriate VA examiner(s) for an addendum opinion to determine the nature and etiology of the Veteran's hypertension. The claims folder and this remand must be made available to the examiner for review, and the examination report must reflect that such a review was undertaken. After a complete review of the record, the examiner must provide an opinion regarding the nature and etiology of the Veteran's hypertension. In rendering this opinion, the examiner must address each of the following: 1. The examiner must include an opinion on whether it is as likely as not (50 percent or more probability) that the Veteran's hypertension is related to service. 2. The examiner must also opine whether it is at least as likely as not (50 percent or more probability) that the Veteran's disability is caused or aggravated by the Veteran's service-connected PTSD or any other service-connected disability. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 4. Thereafter, the issues of service connection for sleep apnea and hypertension, to include as secondary to PTSD, should be readjudicated. If the benefits sought on appeal are not granted, the Veteran and his representative should be provided with a supplemental statement of the case (SSOC) and afforded the appropriate time period within which to respond thereto. J. NICHOLS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael J. O'Connor, 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.