Citation Nr: 21076325 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 16-14 514 DATE: December 23, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected disabilities, including bladder cancer, type II diabetes mellitus and peripheral neuropathy of the bilateral upper and lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Marine Corps from October 1971 to October 1974. The Veteran's appeal was previously before the Board but was remanded to the Agency of Original Jurisdiction (AOJ) for additional development. Specifically, the AOJ was directed to obtain a medical opinion regarding if the Veteran's current obstructive sleep apnea was caused or aggravated by his service-connected diabetes and peripheral neuropathy. The requested opinion was obtained and associated with the claims file in July 2021. The July 2021 medical opinion is adequate because it was based upon consideration of the Veteran's pertinent medical history, his lay assertions and current complaints, and because it describes his obstructive sleep apnea in detail sufficient to allow the Board to make a fully informed determination. Ardison v. Brown, 6 Vet. App. 405, 407 (1994). Accordingly, the Board finds there has been substantial compliance with the remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D'Aires v. Peake, 22 Vet. App. 97, 105 (2008). Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected disabilities, including bladder cancer, type II diabetes mellitus and peripheral neuropathy of the bilateral upper and lower extremities Service connection is also warranted for disability which is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Such secondary service connection is warranted for any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. 38 C.F.R. § 3.310(b). While the Board regrets the additional delay, the Veteran's claim must be remanded for further development. In a November 2021 appellate brief, the Veteran's representative asserted that the Veteran's current obstructive sleep apnea was caused or aggravated by his service-connected disabilities, including bladder cancer, liver cancer, prostate cancer, type II diabetes mellitus and peripheral neuropathy of the bilateral upper and lower extremities, to include treatment used to treat the Veteran's cancer such as chemotherapy. Although the July 2021 medical opinion addresses whether the Veteran's obstructive sleep apnea was caused or aggravated by his service-connected diabetes and peripheral neuropathy, the medical opinion does not address causation or aggravation regarding the Veteran's other service-connected disabilities. The AOJ previously obtained an opinion with regard to the Veteran's bladder cancer; however, prostate cancer and liver cancer were not addressed, nor was the treatment for the Veteran's cancer addressed. The Board VA's duty to assist includes a duty to provide a medical examination or obtain a medical opinion where it is deemed necessary to decide on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); Duenas v. Principi, 18 Vet. App. 512 (2004); Robinette v. Brown, 8 Vet. App. 69 (1995); McLendon v. Nicholson, 20 Vet. App. 79 (2006). An addendum medical opinion discussing whether the Veteran's obstructive sleep apnea was caused or aggravated by his additional service-connected disabilities is necessary to comprehensively evaluate the claim. Accordingly, the matters are REMANDED for the following action: 1. Return the Veteran's claims file to the examiner who completed the July 2021 so a supplemental opinion may be provided. If that examiner is no longer available, provide the Veteran's claims file to a similarly qualified clinician. The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. A new examination is only required if deemed necessary by the examiner. The examiner must provide an opinion as to: a. Whether the Veteran's obstructive sleep apnea is at least as likely as not (50 percent or greater) proximately due to any service-connected disabilityother than diabetes mellitus and peripheral neuropathyand to specifically including liver cancer, bladder cancer, and prostate cancer, and the treatment for these disabilities, including chemotherapy. b. Whether the Veteran's obstructive sleep apnea is at least as likely as not (50 percent or greater) aggravated beyond its natural progression by any service-connected disabilityother than diabetes mellitus and peripheral neuropathyand to specifically including liver cancer, bladder cancer, and prostate cancer, and the treatment for these disabilities, including chemotherapy. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. G. E. Wilkerson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Riordan, 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.