Citation Nr: 21071941 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-50 859 DATE: December 1, 2021 REMANDED Service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active service from October 2003 to January 2011, to include service in Iraq from December 5, 2007 to February 20, 2009 and Afghanistan from May 23, 2010 to May 2, 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal of rating decision dated in April 2016 issued by a Department of Veterans Affairs (VA) Regional Offices (RO). The Veteran seeks service connection for sleep apnea. He contends that his breathing and snoring problems began during service, and that they have continued since discharge. The Veteran maintains that he snored a lot during service and thereafter, and that his girlfriend has also noted that he has difficulty breathing when he sleeps. He contends that a new examination is warranted because he is currently at a healthy body mass index (BMI) and that it is unrelated to the development of his OSA. First, the Board finds that a remand is necessary to obtain outstanding VA treatment records. On his VA Form 21-526, Fully Developed Claim for (Compensation), received by VA in March 2016, the Veteran reported that he had sought treatment for his OSA from 2016 to the present from the Denver, Colorado VA Medical Center (VAMC). Any VA treatment records are within VA's constructive possession, and are considered potentially relevant to the issues on appeal. A remand is required to allow VA to obtain these records. The Board finds that a remand is also necessary to schedule the Veteran for a VA examination to determine the etiology of his OSA. VA examined the Veteran to determine the etiology of his OSA in July 2017. The July 2017 VA examiner opined, after a review of the available evidence of record, that the Veteran's OSA was less likely than not due to or the result of exposures he experienced while in the Gulf War (GW) theater of operations. The examiner reasoned that body habitus is the most significant risk factor for development of obstructive sleep apnea. To this end, the examiner noted that the Veteran's BMI was in the normal range during military service, and that it had increased to over 28 (overweight) in August 2015. The examiner noted that 2015 was the first time the Veteran reported having daytime somnolence, snoring and witnessed apnea and that that was over three (3) years after service separation. The examiner noted that a January 2016 sleep study supported the diagnosis of OSA with a specific recommendation for weight loss. The examiner also indicated that The Institute of Medicine publication "Gulf War and Health: Volume 10: Update of Health Effects of Serving in the Gulf War, 2016" stated that there was inadequate/insufficient evidence to determine whether an association existed between exposure experienced in the GW Theater of Operations and the development of respiratory diseases. See July 2017 VA opinion. The Board finds that the VA examiner's opinion to be inadequate in adjudication of the claim. In this respect, the Veteran has provided statements regarding his chronic symptoms of sleep disturbance since active service, and his current physical status of a having a healthy BMI. Given his statements and contentions, and the absence of discussion of the relevant evidence of record, notably the Veteran's statements of having had sleeping problems since military service, the Board finds that another VA examination is required. The matter is REMANDED for the following action: 1. Obtain the Veteran's outstanding VA treatment records from the Denver, Colorado VAMC, dated from 2016 to the present. 2. Schedule the Veteran for a VA examination to evaluate the etiology of his OSA. The examiner is asked to answer the following question: Is it at least as likely as not (meaning probability of 50 percent or greater) that the Veteran's sleep apnea began in or was otherwise caused by the Veteran's active military service, to include as a result of exposure to environmental hazards while stationed in Iraq and Afghanistan? Why or why not? In answering this question, the examiner should discuss the role of the Veteran's BMI, if any, in the development of his OSA, to include the July 2017 VA examiner's opinion, and the Veteran's contention that he currently is at a healthy BMI and that it is unrelated to the development of his OSA. In addressing the etiology, the examiner should expressly discuss whether it is at least as likely as not that the symptomatology reported by the Veteran's statements that he has had difficulty breathing/snoring to be consistent with OSA having its onset during his period of military service. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Carole Kammel, 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.