Citation Nr: 21073565
Decision Date: 12/09/21	Archive Date: 12/09/21

DOCKET NO. 18-49 530
DATE: December 9, 2021

REMANDED

Entitlement to service connection for sleep apnea, to include as secondary to service-connected chronic rhinosinusitis, is remanded.

REASONS FOR REMAND

The Veteran served on active duty from June 1985 through December 1989.  

This matter comes before the Board of Veterans' Appeals (BVA or Board) on appeal from a February 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran was provided a hearing before the undersigned Veterans Law Judge in August 2021.

1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected chronic rhinosinusitis, is remanded.

The Veteran contends that his sleep apnea is related to his service. Alternatively, he asserts that his sleep apnea was caused or aggravated by his service-connected chronic rhinosinusitis.

In December 2017, treatment notes document that the Veteran reported to a sleep clinic for testing. His chief complaint at the time was snoring. A diagnosis of sleep apnea was rendered after a sleep study.

At the August 2021 hearing, the Veteran testified that he had snoring in service that would cause swelling in the back of his mouth. In service, he was treated with antibiotics for the swelling. Post-service, he was told that he could have a surgery that would improve both his sleep apnea and rhinitis.

The Board cannot make a fully-informed decision on the issue of entitlement to service connection for sleep apnea because no VA examiner has opined whether the Veteran's current sleep apnea disabiliuty is related to his reports of snoring in-service, or was caused or aggravated by his service-connected chronic rhinosinusitis. Thus, further development is necessary. 

The matters are REMANDED for the following action:

1. Ask a qualified examiner to review the relevant evidence and provide opinions on the following medical questions:

a. whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran's sleep apnea is related to his active duty service? In formulating an opinion, the clinician must consider all relevant evidence, to include the Veteran's lay statements asserting that he had snoring, and resulting swelling in the back of his mouth, shown in service. 

b. whether the Veteran's sleep apnea is at least as likely as not (i.) caused or (ii) aggravated beyond its natural progression by his service-connected chronic rhinosinusitis. Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. 

The examiner is asked to provide the underlying reasons for all opinions expressed, and is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. 

 

 

Bethany L. Buck

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N.B. Mmeje, 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.