Citation Nr: 21069453
Decision Date: 11/18/21	Archive Date: 11/18/21

DOCKET NO. 16-32 568
DATE: November 18, 2021

REMANDED

Entitlement to service connection for sleep apnea, to include as secondary to service-connected disabilities, is remanded.

REASONS FOR REMAND

The Veteran had active duty service from August 1982 to February 1986.  

This matter comes before the Board of Veterans' Appeals on appeal from a May 2015 rating decision of a VA Regional Office (RO).  

This matter was previously remanded for additional development in May 2021.  

1. Entitlement to service connection for sleep apnea is remanded.

The Veteran claims service connection for sleep apnea, to include as secondary to service-connected disabilities.  

A polysomnogram in January 2015 showed a diagnosis of severe obstructive sleep apnea.  

In June 2021, a VA examiner opined that sleep apnea is less likely than not related to service.  As rationale, the examiner noted that there were no diagnoses in service or sleep apnea or sleep-related issues.  The Veteran reported snoring in service.  The examiner noted that, although the Veteran reported that snoring began in service and a buddy statement supports the onset of snoring during service, according to Mayo Clinic, many people who snore do not have OSA.  The examiner opined that obesity is a risk factor, but there is no evidence that obesity began in service.  The opinion did not address whether obesity is related to any of  the Veteran's service-connected disabilities.  Service connection is in effect lumbosacral strain, radiculopathy of the right and left lower extremities, right knee total arthroplasty, and right thigh strain.  A remand is necessary for a medical opinion that addresses the Veteran's entitlement to service connection on a secondary basis.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion regarding the etiology of the Veteran's sleep apnea.  An examination should only be scheduled if found necessary by the VA examiner.  The examiner should review the claims file and answer the following questions: 

(a)	Is it at least as likely as not that the Veteran's diagnosed obstructive sleep apnea is (1) proximately caused or (2) aggravated beyond its normal progression by the Veteran's service-connected disabilities with obesity as an intermediate step?  

The examiner is advised that service connection is in effect for lumbosacral strain with degenerative changes, right total knee arthoplasty, radiculopathy of the lower extremities, and right thigh strain.  

If the answer to the question is affirmative, the examiner should answer the following questions:

(b)	Is it at least as likely as not that the Veteran's obesity was a substantial factor in causing the Veteran's obstructive sleep apnea?

(c)	Is it at least as likely as not that the Veteran's obstructive sleep apnea would not have occurred or would not have been aggravated beyond its natural progression without the obesity caused by a service-connected disability?

The examiner should provide a rationale for all opinions expressed.

 

 

J. NICHOLS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Catherine Cykowski

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.