Citation Nr: 21068071 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 16-05 477 DATE: November 9, 2021 REMANDED Entitlement to service connection for sleep apnea, claimed as insomnia, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1979 to November 1982, followed by various periods of active duty for training (ACDUTRA) in the Army Reserve with retirement in April 2012. This issue was before the Board in June 2017. The Veteran appealed the issue to the United States Court of Appeals for Veterans Claims (Court). The Court issued a May 2018 joint motion for partial remand (JMPR), vacating this part of the June 2017 Board decision. As a result, the Board remanded the issue in a December 2018 decision for further development. This issue returned to the Board and was denied in an April 2020 Board decision. The Veteran appealed the decision to the Court. The Court issued a December 2020 joint motion for remand (JMR), vacating the April 2020 Board decision. As a result, the issue is again returned to the Board for appellate review. Entitlement to service connection for sleep apnea, claimed as insomnia, is remanded. Remand is required to obtain an addendum VA opinion, or a new VA examination if necessary. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). On the April 2012 service treatment record (STR) reserve retirement report of medical assessment, the Veteran reported that his health has worsened since his last medical assessment and he experiences worsening ability to go to sleep. The Veteran stated he had chronic recurrent insomnia. The Veteran also indicated that he had frequent trouble sleeping. The Veteran explained that he wakes up two to four times a night. The medical provider also noted the Veteran experiences insomnia one time a year. In a January 2015 Department of Army memorandum, received by VA in February 2016, Dr. T.A. stated that the Veteran's insomnia is related to his sleep apnea. On the February 2015 claim, the Veteran stated his sleep apnea began during service in the Army Reserve in 2011. He stated he was prescribed medication to aid with sleeping. On the March 2016 substantive appeal, the Veteran stated that he was prescribed medication for insomnia during service. He stated he began having difficulty with sleeping during service. He stated that in a treatment letter from Dr. T.A., he was informed he had sleep apnea. On the July 2019 VA examination, the Veteran stated the disorder began in 2010 with symptoms of waking up five times a night with trouble breathing and gasping for air. He stated that a private treatment provider referred him to a cardiologist, and he was then referred to a sleep specialist who performed a sleep study. Here, the July 2019 VA examiner opined that the Veteran's sleep apnea is less likely than not caused by service. The examiner reasoned that there is no record of events to show the chronicity of condition from prior to service, in service, to the current diagnosis of sleep apnea. The examiner stated that the separation examination made no reference to sleep pathology in 1982. The examiner noted that the 2012 retirement examination noted Veteran is normal to claimed conditions. The examiner also noted that the first finding of sleep apnea occurred in a September 2014 private sleep study. The examiner stated that on examination, the Veteran's deviated septum is likely to cause difficulty with nasal breathing and is more likely a contributor to sleep apnea. However, as the July 2019 VA examiner did not address the Veteran's statement of in-service onset or complaints of trouble sleeping and insomnia during service, the issue must be remanded for an addendum VA opinion, or new VA examination if necessary. The matters are REMANDED for the following action: Obtain an addendum VA opinion, or a new VA examination if necessary, from an appropriate clinician to determine the nature and etiology of the Veteran's sleep apnea. The examiner must review the entirety of the Veteran's claims file, including his statements regarding in-service onset and continuity of symptoms of difficulty sleeping. The examiner must then provide a thorough opinion as to whether the disability is at least as likely as not related to an in-service injury, event, or disease during his period of active service from November 1979 to November 1982, or any period of ACDUTRA or INACDUTRA. In rendering this opinion, the examiner must specifically address the Veteran's statements of the onset of symptoms in 2010 during service with the Army Reserve and the April 2012 Army Reserve retirement examination showing reports of frequent trouble sleeping and chronic insomnia. The examiner must address the January 2015 Department of Army memorandum (received by VA February 2016) by Dr. T.A. stating that the Veteran's insomnia is related to the Veteran's sleep apnea in the medical opinion. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thompson, 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.