Citation Nr: 21068478 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 16-00 164A DATE: November 10, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from November 2000 to August 2007. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In the January 2016 substantive appeal, the Veteran requested a hearing before the Board. A hearing was scheduled for February 28, 2019, but the Veteran did not appear at the hearing and did not explain her absence. Therefore, the Veteran's request for a Board hearing is deemed withdrawn. See 38 C.F.R. § 20.704. The Veteran contends that her sleep apnea was caused by her active duty service, to include as secondary to her service-connected depressive disorder and hypertension. See January 2016 Substantive Appeal. In support of her claim, the Veteran submitted a June 2015 private medical opinion by Dr. L.K. who noted that sleep apnea may contribute to high blood pressure and heart disease. Unfortunately, this opinion does not answer the question of whether the Veteran's sleep apnea was caused by her service-connected hypertension but instead, discusses the symptoms of sleep apnea. In August 2015, a VA medical opinion was obtained where the examiner opined that there was no etiological connection between sleep apnea and her service-connected hypertension and depressive disorder. Since then, the Veteran has submitted medical literature that appears to support her claim of the possible relationship between sleep apnea and depressive disorder and hypertension. Some of these literatures relating to sleep apnea and depression include a November 2005 article titled "Association of Psychiatric Disorders and Sleep Apnea in Large Cohort," and a March 2014 article titled "The Correlation of Anxiety and Depression with Obstructive Sleep Apnea Syndrome." In the Veteran's July 2021 appellate brief, the Veteran included various articles that appear to support her claim. While a VA medical opinion was obtained in August 2015, the Board finds that no VA examination has been afforded the Veteran and further, an addendum VA medical opinion is necessary to address the additional evidence she recently submitted. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to her sleep apnea claim. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken, to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, schedule the Veteran for a VA examination to determine whether it is at least as likely as not (50 percent probability or greater) that any current sleep apnea disability onset during service or is otherwise related to an in-service injury, event, or disease. The examiner should also address whether any current sleep apnea disability is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected depressive disorder and service-connected hypertension. In offering the opinion, the examiner is asked to consider the November 2005 article titled "Association of Psychiatric Disorders and Sleep Apnea in Large Cohort," and the March 2014 article titled "The Correlation of Anxiety and Depression with Obstructive Sleep Apnea Syndrome." The examiner should also consider the medical literature submitted and cited in the Veteran's July 2021 Appellate Brief. The examiner should elicit a full history from the Veteran and consider the lay statements of record. The Veteran is competent to attest to factual matters of which he has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran the examiner should provide a fully reasoned explanation. (Continued on the next page) A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.