Citation Nr: 21068854 Decision Date: 11/15/21 Archive Date: 11/15/21 DOCKET NO. 18-40 104 DATE: November 15, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1988 to February 1992 and from January 1998 to April 2001. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. The Veteran contends that his OSA, which was diagnosed in a September 2016 sleep study, is caused by his service-connected PTSD. VA medical opinion was obtained in December 2017. The examiner stated that the Veteran's OSA was at least as likely as not due to the Veteran's PTSD. As rationale, she stated that weight gain is a risk factor in sleep apnea and "that medical literature supports that PTSD can result in anxiety symptoms leading to overeating and weight gain." In January 2018, the December 2017 VA examiner issued an addendum opinion, opining that the Veteran's PTSD did not cause his OSA. As rationale, she stated that the Veteran does not have current weight gain from overeating related to his PTSD. He also reported that any weight gain is not attributable to his anxiety/PTSD symptoms. The examiner noted that while PTSD can cause impaired sleeping issues it does not cause OSA "except in instances of weight gain increasing soft tissues resulting in obstruction." However, the Board finds that the December 2017 VA medical opinion and January 2018 addendum opinion are inadequate as the examiner did not provide an opinion addressing whether the Veteran's OSA was aggravated by his service-connected PTSD. 38 C.F.R. § 3.310(b); El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (a medical opinion that does not specifically address aggravation is generally inadequate to decide a secondary service connection claim). The Board acknowledges that the Veteran believes his service-connected PTSD causes his current OSA, and that he furnished a medical opinion from his VA primary care physician, Dr. A.A., in November 2020 in support of his claim. The Board finds that a VA addendum opinion should be obtained with complete rationale as to whether the Veteran's OSA was caused or aggravated by his service-connected PTSD. The examiner must also consider the Veteran's November 2020 Board hearing testimony. The matter is REMANDED for the following actions: 1. Send the Veteran's claims file to an appropriate medical professional to obtain addendum opinion regarding the etiology of his OSA. The Veteran's entire electronic claims file must be made accessible to the designated professional for review. A detailed rationale for any opinion expressed should be provided. Following the review of the claims file, the medical opinion provider is then requested to respond to the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's OSA is proximately due to or caused by his service-connected PTSD? (b) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's OSA has been aggravated (made worse beyond its natural progression) by his service-connected PTSD? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. When rendering the requested opinions, the examiner must consider the Veteran's November 2020 Board hearing testimony. If the requested opinion cannot be provided without a new examination, one should be scheduled. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kovacs, 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.