Citation Nr: 21074632 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 16-07 609 DATE: December 15, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1974 to August 1977 and from September 1990 to July 1991. This matter is before the Board of Veterans' Appeals (Board) on appeal of a February 2011 rating decision. The Veteran appeared at a hearing before the undersigned Veterans Law Judge (VLJ) in March 2017. This case was last before the Board in July 2021 where the case was remanded to comply with the United States Court of Appeals for Veterans Claims (Court) November 2020 Joint Motion for Remand (JMR). The Court remanded the issue and stated that the Board was required to obtain a new VA medical opinion. The Court also stated that the examiner should address the Veteran's testimony that she started noticing problems sleeping and breathing in 1991 while serving in Desert Storm, as well as addressing her reports of sleeping problems, including snoring since 1991, as noted in the January 2010 Statement in Support of Claim. The July 2021 Board remand directive requested that the September 2018 examiner explain why it would be speculative to ascribe service connection for the Veteran's condition as noted in the September 2018 medical opinion. The examiner was also requested to address the Veteran's testimony that she started noticing problems sleeping and breathing in 1991 while serving in Desert Storm, as well as her reports of sleeping problems, including snoring, since 1991, as noted in the January 2010 Statement in Support of Claim, per the Court's request. The Veteran was afforded a VA opinion in October 2021. The examiner again rendered a negative opinion. However, the examiner failed to address why it would be speculative to ascribe service connection for the Veteran's OSA. The examiner stated that if the Veteran's subjective in-service complaints of OSA were her first symptoms, then one would have expected a diagnosis closer to the time of separation. The examiner's rationale failed to address the July 2021 remand directives. The examiner summarily dismissed the Veteran's complaints due to the length of time before the Veteran was diagnosed with OSA and did not opine as to why it would be speculative to ascribe service connection. The Board finds there has not been substantial compliance with the previous remand directives regarding entitlement to service connection for OSA. Another remand is required in order to effectuate the Board's prior remand instructions, which are copied in large part below. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: Return the Veteran's claim folder to the examiner who conducted the October 2021 VA opinion. If an additional examination is deemed necessary, one should be scheduled. If the prior examiner is not available, the entire claims file must be forwarded to another examiner to obtain the requested opinion. a.) The examiner is to provide an opinion as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that any current diagnosed sleep apnea disorder had its onset during, or is otherwise etiologically related to, the Veteran's active duty service. b.) Separately, provide an opinion as to whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the Veteran's sleep apnea disorder was caused or aggravated by the service-connected PTSD. In rendering the opinion, the VA examiner is to explain specifically why it would be speculative to ascribe service connection for the Veteran's condition, as noted in the September 2018 VA medical opinion, in addition to addressing the Veteran's testimony that she started noticing problems sleeping and breathing in 1991 while serving in Desert Storm, as well as her reports of sleeping problems, including snoring, since 1991, as noted in the January 2010 Statement in Support of Claim, per the Court's request. A complete rationale must be provided for all opinions expressed and conclusions reached. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hetman 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.