Citation Nr: 21068835 Decision Date: 11/15/21 Archive Date: 11/15/21 DOCKET NO. 15-05 646 DATE: November 15, 2021 REMANDED Entitlement to service connection for a recurrent sleep disability, to include obstructive sleep apnea, is remanded. REASONS FOR REMAND The Veteran had active service from June 1980 to July 1989. Entitlement to service connection for a recurrent sleep disability, to include obstructive sleep apnea, is remanded. Service connection may be granted for disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for tonsillitis residuals, right shoulder rotator cuff strain residuals, left shoulder rotator cuff strain residuals, right total knee arthroplasty residuals, right knee and right thigh scars, left knee meniscal tear residuals, generalized anxiety disorder, dysthymic disorder, hypertension, tinnitus, and erectile dysfunction. A November 2017 Department of Veterans Affairs (VA) treatment record states that the Veteran reported that "the patient reports that pain significantly interferes with sleep." A September 2021 evaluation conducted for VA states that "obstructive sleep apnea, mental health condition, tonsillitis, hypertension, bilateral shoulder and bilateral knee conditions, and medications are separate entities and are not medically related are separate entities and are not medically related" and "there is a lack of sufficient objective medical evidence noted to confirm or support a conclusion of permanent aggravation beyond normal progression." The examiner commented that: "according to the American Sleep Apnea Association, obstructive sleep apnea, or OSA, arises from what is basically a mechanical problem;" "it is complete or partial upper airway obstruction during sleep;" "during sleep the tongue falls back against the soft palate and the soft palate and uvula fall back against the back of the throat, effectively closing the airway;" "the tonsils are the two oval-shaped pads of tissue at the back of the throat;" "if these tonsils become reddened and inflamed, this is what is referred to as tonsillitis" and "symptoms of tonsillitis can include red swollen tonsils, white or yellow coating or patches on the tonsils, sore throat, difficult or painful swallowing, or fever." The nurse practitioner did not note or otherwise address either the relationship of the concurrent "back of the throat" impairment, if any, associated with the diagnosed obstructive sleep apnea and the service connected tonsillitis residuals or the relationship between the obstructive sleep apnea and the documented impaired sleep due to pain associated with the multiple service connected shoulder and knee disabilities. In light of such deficiencies, the Board finds that the September 2021 VA evaluation is of limited probative value. When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board of Veterans' Appeals (Board) finds that further VA obstructive sleep apnea examination is needed. Clinical documentation dated after August 2021 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated the diagnosed obstructive sleep apnea. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain any VA treatment records not of record, to include those pertaining to treatment after August 2021. 3. Schedule the Veteran for a VA obstructive sleep apnea examination conducted by a medical doctor to assist in determining the nature and etiology of the diagnosed obstructive sleep apnea disability. The examiner must review the record and should note that review in the reports. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all recurrent sleep disabilities found. (b) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified recurrent sleep disability had its onset during active service or is related to any incident of service. (Continued on the next page) (c) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified recurrent sleep disability is due to or the result of the tonsillitis residuals and the other service-connected disabilities. (d) Opine whether it is at least as likely as not (a 50 percent probability or greater) that any identified recurrent sleep disability has been aggravated (increased in severity beyond the natural progression of the disorder) by the tonsillitis residuals and the other service connected disabilities. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.R. Kardian, 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.