Citation Nr: 21073686 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 19-34 742 DATE: December 10, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) secondary to posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served honorably in the Army from March 1966 to March 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for OSA. The Veteran's claim was originally denied in a September 2018 rating decision. The Veteran filed a motion for reconsideration of the September 2018 rating decision in December 2018. The RO conducted additional development including affording the Veteran a OSA VA examination (VAX) in December 2018. The Veteran's claim was denied again in a December 2018 rating decision. The Veteran filed a notice of disagreement (NOD) in October 2019. The Board will consider the Veteran's filings as a continuous prosecution of the original claim. Entitlement to service connection for OSA secondary to PTSD is remanded. The Board finds that the medical opinions of record are inadequate. An August 2018 private medical opinion is inadequate as it is speculative in nature. The examiner determined that it is very likely that the Veteran's OSA could have resulted from complications of his military service. See Bloom v. West, 12 Vet. App. 185 (1999) (use of "could have" in medical opinion is speculative). The December 2018 VA medical opinion is also inadequate. First, the VA examiner conflated causation with aggravation. Second, the rationale used to support the negative nexus opinion is conclusory. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two); see also Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (a mere conclusory opinion is insufficient to allow the Board to make an informed decision as to the weight to assign to a medical opinion). Third, without any explanation the examiner left the aggravation section of the form blank. Fourth, since the VA medical opinion was provided in December 2018 the Court has redefined the definition of aggravation. Specifically, in Ward v. Wilkie, 17-1204, the Court held that a "permanent worsening" of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation may include temporary worsening of a disability). As part of its duty to assist veterans, VA must ensure that VA examinations (VAXs) or medical opinions are adequate once VA provides them. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Thus, a remand is required to obtain an addendum opinion. The matter is REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the OSA from a VA examiner, who has not previously provided an opinion in this case. The entire claims file must be made available to and be reviewed by the examiner. If the examiner finds that a physical examination is needed, such should be scheduled. The examiner must address whether it is at least as likely as not (50 percent or greater probability) that the Veteran's OSA a. had its initial onset in service or was otherwise a result of his active service, b. was caused by his service-connected PTSD, c. underwent any incremental increase in disability, regardless of its permanence, due to a service-connected PTSD i.e. was aggravated. The term "incremental increase in disability" means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any "incremental increase in disability" need not be permanent. Rationale for the requested opinions shall be provided. M.W. Kreindler Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Smith, 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.