Citation Nr: 21070649 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 16-27 910 DATE: November 24, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as due to exposure to environmental hazards in the Gulf War, is remanded. REASONS FOR REMAND The Veteran service on active duty in the Navy from January 2010 to January 2011. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Roanoke, Virginia. In February 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ) during a virtual hearing. A transcript of the hearing is of record. The Veteran contends that his current sleep apnea is directly related to his active duty service, to include as due to exposure to environmental hazards in the Gulf War. The Board notes that, as of this date, the Veteran has not been afforded a VA examination/medical opinion assessing the etiology of his claimed condition, and thus, a remand is necessary for additional development prior to adjudication of the claim. Pursuant to VA's duty to assist regarding a claim for disability compensation, the VA must afford a veteran a medical examination and/or obtain a medical opinion when, after review of the record, the VA finds it necessary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4). In service connection claims, such as the case here, VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-82 (2006). The Board acknowledges the Veteran has the current disability of obstructive sleep apnea, based on the assessment of competent and credible VA medical evidence in the record. See 38 U.S.C. § 5103A(d)(2)(A); see also Charles v. Principi, 16 Vet. App. 370, 374 (2002). The record also suggests a possible relationship between this current disability and the Veteran's service, as the Veteran contends his current sleep apnea had its onset during his active service in Kuwait, or is otherwise related to his in-service environmental exposure during his service in Kuwait. See Hearing Transcript, February 2021. The Board notes that the Veteran's service records reveal that he served in Southwest Asia, specifically in Kuwait, and VA has conceded to his in-service exposure to environmental hazards during the Persian Gulf War. See SSOC, April 2018. As such, given the "low threshold" standard for determining when a VA examination is necessary, the Board finds that the requirements have been met. Consequently, the Board finds that a remand for such examination is necessary. McLendon, 20 Vet. App. 79, 81 (2006). The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his sleep apnea and obtain any outstanding records and associate them with the Veteran's claims file. 2. After associating all newly acquired records with the claims file, schedule the Veteran a VA examination by an appropriate clinician to determine the nature and etiology of the Veteran's sleep apnea. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. Following complete review of the record, the examiner must address the following: (a) Opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea had its onset during any period of active duty, or is otherwise etiologically related to his active duty service, to include his conceded exposure to environmental hazards while serving in Kuwait. Please note: in the requested the opinion, the examiner must discuss and address the various lay statements submitted from the Veteran regarding the onset of symptoms and continuity of symptomatology. (b) Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion. (c) If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.