Citation Nr: 21075706 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 19-00 708 DATE: December 21, 2021 REMANDED Entitlement to service connection for sleep apnea, claimed as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from September 1980 to September 1992. This matter comes before the Board of Veterans Appeals (Board) from a November 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran participated in a December 2021 hearing before the undersigned Veterans Law Judge (VLJ). 1. Entitlement to service connection for sleep apnea, claimed as secondary to service-connected disabilities, is remanded. The Veteran seeks service connection for sleep apnea secondary to his service-connected disabilities. See Hearing Transcript December 2021. VA medical center (VAMC) treatment records reflect that the Veteran has a diagnosis of obstructive sleep apnea (OSA). See e.g., VA medical records from May 2013, August 2018, and December 2020. The Veteran was formally diagnosed with obstructive sleep apnea in a September 2012 sleep study. At the December 2021 Board hearing, the Veteran through his attorney clarified that his sleep apnea was not being claimed as directly related to service but instead argued it should be considered as secondary to his service-connected disabilities, in particular his lumbar spine disability. The Veteran's attorney also raised questions as to whether the medications prescribed for the Veteran's lumbar spine and other service-connected disabilities may have secondarily caused or aggravated his sleep apnea. They further noted the Veteran had an 80 percent combined disability rating for his orthopedic conditions and related complications, which they asserted affects the Veteran's mobility. The implication is these conditions might have led to his obesity and ultimately to his sleep apnea. Finally, the Veteran and his attorney also submitted treatise evidence in December 2021, which cite several studies showing a relationship between chronic back pain and the interruption of sleep and development of sleep apnea. The Veteran has not been provided a VA examination to assess the nature and etiology of the disability. In light of the foregoing contentions and evidence submissions, the Board finds a VA examination for a medical opinion is necessary. The matter is REMANDED for the following action: 1. Arrange for an VA examination and medical opinion from a qualified VA medical professional regarding the Veteran's claim of service connection for obstructive sleep apnea. The claims file should be made available to and be reviewed by the examiner. (a.) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was caused by his back disability or any other service-connected disability. (b.) The examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was aggravated beyond its natural progression by his back disability or any other service-connected disability. (c.) The examiner should also opine whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's service-connected disabilities (to include lumbar degenerative joint disease, right ankle strain, left ankle strain, radiculopathy of the right and left lower extremities, and bilateral plantar fasciitis) have caused or aggravated his obesity and, if so, whether the Veteran's obesity is a substantial factor in the development of his sleep apnea, such that the sleep apnea would not have occurred but for the obesity. (Continued on the next page) In answering the above questions, the examiner should address the contentions raised by the Veteran and his attorney at the December 2021 Board hearing, including the impact of any medication taken for his service-connected disabilities and the effect of his service-connected orthopedic conditions and their complications on mobility. The examiner should also address the treatises submitted concerning the relationship between chronic back pain and sleep problems. A complete rationale should be provided for each opinion given. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Stuedemann, A. 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.