Citation Nr: 21071779
Decision Date: 12/01/21	Archive Date: 12/01/21

DOCKET NO. 18-39 720
DATE: December 1, 2021

REMANDED

Entitlement to service connection for obstructive sleep apnea is remanded.

REASONS FOR REMAND

The Veteran had active service from September 1990 to December 1993, January 2007 to May 2008, and from September 2010 to September 2011. 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified before the undersigned Veterans Law Judge by virtual hearing in September 2021.  A transcript of the hearing is of record.

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

The Veteran contends that his sleep apnea, diagnosed by sleep study in March 2015, is caused or aggravated by his service-connected posttraumatic stress disorder (PTSD).  The Veteran testified that he believed his sleep apnea began after taking Zoloft for his PTSD.

The Veteran provided two articles from medical journals suggesting that there was a connection between PTSD and sleep apnea.  The Veteran has not yet been afforded a VA examination. An examiner will now have an opportunity to review this treatise evidence.

The matters are REMANDED for the following action:

Obtain an opinion from an appropriate clinician concerning whether there is a causal nexus between the Veteran's obstructive sleep apnea and his service-connected PTSD. The need for an in-person examination is left to the examiner's discretion. 

The examiner is asked to opine whether the Veteran's obstructive sleep apnea is at least as likely as not: (1) proximately due to; or (2) aggravated (i.e., worsened beyond its natural progression) by his service-connected PTSD, to include Zoloft prescribed to treat such.

The examiner is advised that causation and aggravation are independent concepts. As such, the examiner must provide separate opinions and rationales for proximate causation and aggravation. The examiner is also advised that aggravation under 38 C.F.R. § 3.310 (b) does not require that there be "permanent" worsening of the nonservice-connected disability. 

The examiner should review the claims file and medical literature provided by the Veteran, in connection with authoring the opinion.  Rationale for the opinions must be provided. 

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A complete rationale is one that contains clear conclusions with supporting data and a reasoned medical explanation connecting the two.

 

 

D. JOHNSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. G. Mazzucchelli, 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.