Citation Nr: 21071368 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 17-02 933 DATE: November 30, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as due to Gulf War exposures, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1990 to October 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). By way of background, this issue was previously denied by the Board in January 2020 and February 2021. Regarding the January 2020 Board denial, the Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2020 Court Order, pursuant to a September 2020 Joint Motion for Remand (JMR), the Court vacated the Board's January 2020 decision and remanded the claim for action consistent with the terms of the parties' JMR, which included addressing whether 38 C.F.R. § 3.317 regarding Gulf War Veterans applied and to consider whether the Veteran's sleep apnea was an undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI). Regarding the February 2021 Board denial, the Veteran appealed the decision to the Court, and in an August 2021 Court Order, pursuant to the August 2021 JMR, the Court vacated the Board's February 2021 decision and remanded the claim for action consistent with the terms of the parties' JMR, which included properly addressing the etiology of the Veteran's sleep apnea and whether it qualifies as a MUCMI. As such, the claim is again before the Board. In the JMR, the parties agreed that the Board failed to properly address whether the Veteran's sleep apnea qualifies as a MUCMI. An illness is not considered a MUCMI if both the etiology and pathophysiology are at least partially understood. Stewart v. Wilkie, 30 Vet. App. 383, 389-90 (2018). The Board found that the Veteran's sleep apnea was not a MUCMI as its pathophysiology and etiology were at least partially understood. The parties to the JMR particularly contested the Board's finding regarding the etiology prong of a MUCMI. The Board based its finding that the etiology of the Veteran's sleep apnea was at least partially understood on the December 2015 examiner's notation that obstructive sleep apnea can be caused by a history of deviated septum or other problems or risk factors. However, in that same examination, the Veteran was found to not have a history of a deviated septum or other risk factors/problems for the development of sleep apnea during service. In addition, the Board did not provide any additional supporting facts or rationale based on the Veteran's individual circumstances to support this conclusion regarding etiology. In order to cure this agreed-upon error, the Board must remand for a new VA medical opinion and examination (if found necessary) that adequately addresses the provisions of 38 C.F.R. § 3.317. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate examiner, and if found necessary, schedule the Veteran for a VA examination regarding his service connection claim for obstructive sleep apnea. All opinions must be supported by a rationale. The examiner must specifically address whether the Veteran's sleep apnea is attributable to a known clinical diagnosis. If the symptoms are attributable to a known clinical diagnosis, the examiner must then discuss both the etiology and pathophysiology of the condition to which the reported symptoms have been attributed with emphasis on whether both the etiology and pathophysiology of the condition are understood or at least partially understood in the context of his unique circumstances. If any of the claimed symptoms are attributable to a known clinical diagnosis with both an etiology and pathophysiology that are at least partially understood in the context of the Veteran's unique circumstances, the examiner must then address whether the condition is at least as likely as not (50 percent probability or greater) the result of disease or injury in active service, to include exposure to hazards while serving in the Gulf War. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ariasaif, Mary 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.