Citation Nr: 21071632 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-00 122 DATE: December 1, 2021 REMANDED Entitlement to service connection for a recurrent sleep disability, to include sleep apnea, is remanded. REASONS AND BASES FOR REMAND The Veteran had active service from December 1975 to May 1980. Entitlement to service connection for a recurrent sleep disability, to include sleep apnea, is remanded. Service connection may be granted for recurrent disability which is proximately due to or the result of a service connected disease or injury. 38 C.F.R. § 3.310(a). Service connection shall be granted on a secondary basis under the provisions of 38 C.F.R. § 3.310(a) where it is demonstrated that a service connected disorder has aggravated a nonservice connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Service connection has been established for an unspecified anxiety disorder, tinnitus, and bilateral hearing loss. A January 2017 Department of Veterans Affairs (VA) audiological treatment record states that the Veteran reported that the service connected tinnitus affected his sleep disability. The treating VA audiologist noted that "tinnitus pillow kit has been ordered through prosthetics" and "the Veteran was counseled regarding tinnitus and tinnitus coping strategies." The report of a September 2021 sleep apnea examination conducted for VA states that the Veteran was diagnosed with obstructive sleep apnea. The examiner concluded that "the Veteran's current obstructive sleep apnea was less likely than not proximately due to or a result of the Veteran's service-connected tinnitus or bilateral hearing loss" and "less likely than not aggravated beyond its natural progression by the Veteran's service connected tinnitus and bilateral sensorineural hearing loss." The examiner commented that: a "review of the available records reveals no objective evidence of any direct, causal relationship between the noted tinnitus or hearing loss and the development of OSA;" "no objective evidence of any aggravational (sic) relationship between the noted tinnitus or hearing loss and the development of OSA;" "there is not association between the conditions and the airway obstruction leading to obstructive sleep apnea;" and "the primary risk factor in this case for the development of obstructive sleep apnea was obesity with a BMI of 31.7 noted in 2016." The examiner did not note or otherwise address the January 2017 VA clinical documentation relating that the service connected tinnitus affected the diagnosed sleep disability. Given this deficiency, the Board of Veterans' Appeals (Board) finds that the evaluation is of limited probative value. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Further VA sleep apnea evaluation is needed. Clinical documentation dated after February 2018 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claim. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated any sleep disability. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain any VA treatment records not of record, to include those pertaining to treatment after February 2018. 3. Schedule the Veteran for a VA sleep examination conducted by a medical doctor to assist in determining the nature and etiology of any identified recurrent sleep disability, to include the diagnosed obstructive sleep apnea, and any relationship to active service. The examiner must review the record, including the January 2017 VA audiological treatment records. A rationale for all opinions should be provided. The examiner should: (a.) Identify all sleep disabilities found. (b.) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified sleep disability, to include obstructive sleep apnea, had its onset during active service or is related to any incident of service. (c.) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified sleep disability, to include obstructive sleep apnea, is due to or the result of tinnitus and the other service-connected disabilities. (d.) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified sleep disability, to include obstructive sleep apnea, has been aggravated (increased in severity beyond the natural progress of the disorder) by tinnitus and the other service-connected disabilities. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Emily A. Kotroco 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.