Citation Nr: 21067751
Decision Date: 11/05/21	Archive Date: 11/05/21

DOCKET NO. 14-25 203A
DATE: November 5, 2021

REMANDED

Entitlement to service connection for sleep apnea, to include as due to Gulf War environmental hazards, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from November 1981 to June 1992; February 2004 to August 2004; January 2005 to September 2005; and September 2009 to December 2009. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

The matter was remanded in July 2018, September 2020, and June 2021.

Entitlement to service connection for sleep apnea to include as due to Gulf War environmental hazards is remanded.

The Board regrets further delay, but another remand is needed. Specifically, the Veteran has been granted service connection for rhinitis and sinusitis during the pendency of the appeal, which raises the theory of service connection for sleep apnea on a secondary basis, and this theory of entitlement should be addressed on remand through an addendum opinion. 

The appeal is REMANDED for the following action:

Obtain an addendum opinion to determine the etiology of the Veteran's obstructive sleep apnea. The claims file should be made available to and reviewed by the examiner.

Following a review of the claims file, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) the Veteran's obstructive sleep apnea:

(a.) is proximately due to his rhinitis; 

(b.) has been aggravated (worsened beyond natural progression) by his rhinitis;

(c.) is proximately due to his sinusitis; or

(d.) has been aggravated (worsened beyond natural progression) by his sinusitis.

In addressing questions (a)  (d), please render four separate opinions.  The examiner is also advised that it is not necessary for the evidence to demonstrate that sleep apnea existed during military service in order for it to be considered due to or aggravated by rhinitis and/or sinusitis for VA purposes. Moreover, it is not necessary that rhinitis and/or sinusitis be service-connected, or even diagnosed, at the time sleep apnea is incurred, and reliance on this temporal element in support of a negative opinion will render it inadequate.

The examiner must provide a complete rationale for any conclusions reached.  If unable to opine without speculation, please provide a basis for this conclusion.

 

 

S. BUSH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. J. Rogers, 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.