Citation Nr: 21073362 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 17-01 596 DATE: December 8, 2021 REMANDED Entitlement to service connection for coronary artery disease with myocardial infarction and ischemic changes with scarring/damage (heart disability), as due to exposure to non-ionizing radiation, or as secondary to service-connected obstructive sleep apnea, is remanded. REASONS FOR REMAND The Veteran had active service from January 1959 to January 1963. This matter comes before the Board of Veterans' Appeals (BVA or Board) from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in September 2017 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In January 2018, October 2020, and June 2021, the Board remanded this claim for additional development. The Veteran seeks entitlement to service connection for a heart disability. In a November 2021 Written Brief Presentation, the Veteran's representative argues that the Veteran's claimed heart disability is secondary to his service-connected obstructive sleep apnea. Although the Veteran's representative cited to several medical articles as well as VA Clinical Practice Guidelines that indicate obstructive sleep apnea is an independent risk factor for cardiovascular disease, the information is generalized and does not discuss the particular etiology and/or relationship between this Veteran's service-connected obstructive sleep apnea and his coronary artery disease. To date, a VA medical opinion regarding secondary service connection has not yet been obtained. On remand, a VA medical opinion should be obtained. While this case is in remand status, the Veteran and/or his representative is also free to obtain a medical opinion to support his claim, if he so desires. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file all updated treatment records. 2. Obtain an addendum VA medical opinion for the Veteran's claimed heart disability. The examiner is requested to review all pertinent records associated with the claims file, to include this Remand. The examiner should state that the claims file was reviewed. *The examiner should opine as to whether it is at least as likely as not that the Veteran's claimed heart disability is proximately due to OR aggravated (beyond a natural progression) by his service-connected obstructive sleep apnea. In providing this opinion, the examiner is requested to address the following: *Consider and discuss the asserted argument that sleep apnea is well-known to cause or aggravate coronary artery disease, to include the cited VA Clinical Practice Guideline for the Management of Chronic Insomnia Disorder and Obstructive Sleep apnea, which notes obstructive sleep apnea is an independent risk factor for cardiovascular disease, and the cited medical article, "Obstructive Sleep Apnea in Cardiovascular Disease: A Review of the Literature and Proposed Multidisciplinary Clinical Management Strategy." See November 2021 Written Brief Presentation. All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Andersen, 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.