Citation Nr: 21068877 Decision Date: 11/15/21 Archive Date: 11/15/21 DOCKET NO. 18-37 491 DATE: November 15, 2021 REMANDED Service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1959 to March 1963. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision of the Agency of Original Jurisdiction (AOJ). The Veteran testified before the undersigned Veterans Law Judge in February 2020. A transcript of this hearing has been associated with the record. The Board remanded the Veteran's claim in August 2021 in order to obtain an additional opinion addressing the relationship between the Veteran's OSA and his service connected posttraumatic stress disorder (PTSD). In its remand, the Board found a June 2021 etiological opinion to be inadequate. The opinion provided no clear rationale other than stating that medical literature did not indicate that PTSD can cause or aggravate OSA. It was also noted that the negative finding was inconsistent with medical treatise evidence that the Veteran submitted in March 2020 and June 2021 drawing a connection between OSA and PTSD, to include the medications taken in treatment of PTSD. In August 2021, an examiner stated that there was no medical research to "prove" a relationship between PTSD and OSA. The seeming rationale was that OSA was due to biomechanical conditions in the posterior pharynx. In September 2021, the examiner stated that the March 2020 and June 2021 articles were "not scientific evidence of [the] etiology and cause of OSA". The August 2021 and September 2021 opinions are inadequate. The examiner did not offer a rationale explaining these opinions, nor did the examiner address the content of the March 2020 and June 2021 treatise evidence. The examiner instead dismissed such evidence as "not scientific" without further explanation. On remand, the AOJ should obtain an additional etiological opinion addressing the relationship, if any, between the Veteran's service connected PTSD and his OSA. In so doing, the examiner must explain the probative value that should be afforded to the medical treatise evidence that the Veteran has submitted. This matter is REMANDED for the following action: Obtain an addendum opinion from an examiner other than the examiner who offered the August 2021 and September 2021 etiological opinions. Additional physical examination or testing of the Veteran should be conducted if the examiner determines such to be necessary in order to offer the requested opinions. After reviewing the Veteran's claims file, the examiner should address the following questions: (a.) Is it at least as likely as not (that is, a 50 percent likelihood or greater) that the Veteran's OSA is proximately due to his service connected PTSD, to include the medications that he takes in treatment of PTSD? (b.) Is it at least as likely as not (that is, a 50 percent likelihood or greater) that the Veteran's OSA underwent an incremental increase in disability, regardless of its permanence, due to his service connected PTSD, to include the medications that he takes in treatment of PTSD? The term "incremental increase in disability" means an additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. When rendering these opinions, the examiner must discuss the significance of the medical treatise evidence that the Veteran has submitted, including in March 2020 and June 2021. This discussion must clearly address and explain the probative value of such evidence; simply dismissing such evidence as "not scientific" without further explanation is inadequate. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.A. Flynn, 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.