Citation Nr: 21068462 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 15-19 732 DATE: November 10, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (sleep apnea) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1975 to March 1977, with additional Reserve service. This matter comes before the Board of Veterans' Appeals (Board) from a January 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the appeal regarding the issues of service connection for an acquired psychiatric disorder and service connection for a sleep disorder, to include sleep apnea and insomnia in July 2018, August 2019, and September 2020, and March 2021. The Board notes that by a May 2021 rating decision, the RO granted service connection for an acquired psychiatric disorder, to include insomnia. This is a full grant of benefits sought for the issues of service connection for acquired psychiatric disorder and insomnia, and they are no longer on appeal. The appeal concerning service connection for sleep apnea has been returned to the Board for further appellate review. Entitlement to service connection for sleep apnea is remanded The Veteran contends that his sleep apnea is related to his service connected acquired psychiatric disorder, to include insomnia, and service-connected chronic rhinitis. A remand confers on the claimant, as a matter of law, the right to compliance with the remand order and imposes upon the VA a duty to ensure compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998). Consistent with this, once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The March 2021 Board remand directed that the examiner address whether it is at least as likely as not that the Veteran's sleep apnea incurred during military service or was caused or aggravated by any service-connected disease or injury. The Veteran was afforded a VA sleep apnea examination in April 2021. The examiner opined that the Veteran's sleep apnea is less likely than not related to his military service because the diagnosis occurred 28 years after service. The examiner also opined that the sleep apnea was less likely than not caused by or aggravated by insomnia or rhinitis because insomnia and rhinitis are not medically related to obstruction of sleep apnea. The RO determined that the April 2021 examiner did not include sufficient rationale for the sleep apnea opinion and an addendum opinion was provided in August 2021. The Board must be able to conclude that a medical expert has applied valid medical analysis to the significant facts of the particular case in order to reach the conclusion submitted in the medical opinion." See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); see also Stefl v. Nicholson, 21 Vet. App. 120 (2007) (holding that "a mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to a doctor's opinion"). The provider gave the same opinion regarding direct service connection, basing the rationale on the diagnoses being 28 years after service and a lack of medical records. However, a lack of evidence cannot be corroborating to conclude that there is no relationship between the Veteran's current disability and his military service. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Additionally, the examiner also opined that insomnia or rhinitis less likely than not caused or aggravated the sleep apnea because insomnia and rhinitis are not medically related to the obstruction of sleep apnea. The examiner stated that rhinitis makes nose breathing difficult and mouth breathing normally compensates, also not causing the kind of obstruction in sleep apnea. However, the examiner did not provide any explanation as to whether the Veteran's service-connected conditions aggravate his sleep apnea. Moreover, the examiner did not address whether the Veteran's service-connected acquired psychiatric disorder caused or aggravated his sleep apnea. Therefore, a new opinion is needed to address the Veteran's sleep apnea and its relation to his service-connected disabilities. Based on the foregoing reasons, remand is warranted for further development. The matters are REMANDED for the following action: 1. Associate with the claims file any outstanding VA medical records. Obtain an addendum medical opinion by a different, appropriate clinician to determine the nature and etiology of the Veteran's sleep apnea. The examiner must review the entire claims file, to include this remand. Another VA examination should be scheduled only if determined necessary by the examiner. If the examiner determines that another VA examination is necessary, any evaluations, studies, or tests deemed necessary by the examiner should be accomplished and any such results must be included in the examination report. The examiner must provide the following: a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was incurred in or is otherwise related to active service? b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was caused OR aggravated by any service-connected disease or injury, to include rhinitis or psychiatric condition? The examiner is advised that aggravation is defined as any increase in severity of a disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease or injury. The examiner is advised that the Veteran is competent to report symptoms and treatment and that his reports, including his reports as to the onset and nature of his symptoms, must be considered, along with the other evidence of record, in formulating the requested opinions. A complete rationale for any opinions expressed should be set forth. If the examiner cannot provide an above opinion without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). A. J. Spector Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Temple, 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.