Citation Nr: 21071021 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 16-52 569 DATE: November 29, 2021 REMANDED Entitlement to service connection for sleep apnea, as secondary to service-connected acquired psychiatric disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from July 1976 to November 1976 and in the U.S. Air Force from December 1976 to October 1978. The issue was remanded by the Board of Veterans' Appeals (Board) in December 2018 and June 2021 for further development. The most recent remand in June 2021 specifically instructed the regional office (RO) to obtain an addendum medical opinion pertaining to the Veteran's claim. Upon review of the record, the Board finds that the claim must be remanded. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claim. Entitlement to service connection for sleep apnea, as secondary to service-connected acquired psychiatric disorder, is remanded. The Board finds that a new VA examination and etiological opinion is warranted for the Veteran's claim. The Veteran contends that his sleep apnea is secondary to his service-connected psychiatric disorder. An addendum opinion provided by a VA examiner was associated with the Veteran's claims file in July 2021, in which the examiner opined that the Veteran's sleep apnea was not aggravated beyond its natural progression by the Veteran's acquired psychiatric disorder. However, the July 2021 examiner used the incorrect definition for her aggravation opinion for secondary service connection. Per a decision from the United States Court of Appeals for Veterans Claims (Court), permanent worsening need not be shown. Any incremental increase in disability and any additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence constitutes aggravation. Ward-Neal v. Wilkie, 31 Vet. App. 233 (2019). As such, remand for a new examination is warranted to adequately address the nature and etiology of the Veteran's claimed hepatitis C. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of the Veteran's sleep apnea. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and conducting an examination of the Veteran, the examiner should respond to the following: (a.) State whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's sleep apnea was caused or aggravated by the Veteran's service-connected acquired psychiatric disorder. An opinion as to both causation and aggravation is requested. The examiner must specifically discuss the article submitted by the Veteran that discusses a link between depression and sleep apnea. (b.) If the examiner finds that the Veteran's sleep apnea was aggravated by his service-connected acquired psychiatric disorder, then he/she should specify the baseline level of disability of the sleep apnea prior to aggravation due to the service-connected acquired psychiatric disorder. Note that aggravation means any incremental increase in disability in the sleep apnea (i.e., any additional impairment of earning capacity) resulting from the service-connected acquired psychiatric disorder. If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, 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.