Citation Nr: 21071496
Decision Date: 11/30/21	Archive Date: 11/30/21

DOCKET NO. 17-50 712
DATE: November 30, 2021

REMANDED

Entitlement to service connection for obstructive sleep apnea is remanded.

REASONS FOR REMAND

The Veteran served on active duty from March 2002 to May 2002 and from March 2003 to May 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This claim was last before the Board in April 2019 where it was remanded for additional development.

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

The Veteran contends that his obstructive sleep apnea is secondary to his service-connected posttraumatic stress disorder (PTSD) and musculoskeletal disabilities. The Veteran essentially asserts that his service-connected PTSD and musculo-skeletal disability (residuals of right wrist fracture) led to obesity that ultimately caused the claimed obstructive sleep apnea. Specifically, the Veteran has asserted that due to his mental health condition and fatigue, he had been less motivated to exercise, and it has led him to make poor food choices to eat high calorie foods including sweets and comfort foods. He attributed his weight gain to both his mental health and musculoskeletal disability. See July 2016 VA 21-526EZ; April 2017 statement; April 2017 notice of disagreement; October 2017 representative's brief; and March 2019 representative's brief.

In accordance with prior remand instructions, addendum opinions were obtained in July 2019, October 2020, and November 2020. The VA examiner was asked   to "address the Veteran's contention that his service-connected PTSD and musculoskeletal disability (the right wrist) caused weight gain (obesity) that contributed to the onset and worsening of obstructive sleep apnea. (i.e., the level of his obesity, if any, that is attributable to his service-connected disabilities.)." See April 2020 Board Remand.

In response to the above instruction, the VA examiner opined "obesity is associated with obstructive sleep apnea but not a causative factor," and the "Veteran's depression may have led him to make poor choices as he claims but there is no credible, medical literature that asserts PTSD and musculoskeletal conditions cause obesity."  The Board finds this opinion to be conclusory. The VA examiner did not adequately consider whether the Veteran's PTSD symptoms are related to his obesity. Thus,    this rationale is inadequate. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007)  ("[A] medical opinion must support its conclusion with an analysis that the Board   can consider and weigh against contrary opinions"). As such, an addendum opinion  is warranted. 

The matter is REMANDED for the following action:

1. Send the claims file to an appropriate examiner to obtain an addendum opinion with respect to the Veteran's obstructive sleep apnea claim. The claims file must be reviewed by the examiner. If a new examination is deemed necessary to respond to the request, one should be scheduled. 

After review of the claims file, the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran's obstructive sleep apnea was either caused or aggravated beyond its natural progression by his service-connected PTSD or service-connected musculoskeletal disability (right wrist), to include addressing his PTSD symptoms and his contention that due to his mental health condition and fatigue, he had been less motivated to exercise, and it has led him           to make poor food choices to eat high calorie foods including sweets and comfort foods, thereby leading to his weight gain. The examiner should explain why or why not.

2. If the claim remains denied, issue a supplemental statement of the case.

 

 

K. A. BANFIELD

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	G. N. Wilson, 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.