Citation Nr: 21076506 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 17-31 152 DATE: December 27, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea on a direct service connection basis and as caused by service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1971 to April 1973. This matter is before the Board of Veterans' Appeals (Board) on appeal from a November 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). A Board hearing was held before the undersigned in December 2019. A transcript of the hearing is of record. This matter was previously before the Board in February 2020 and January 2021 when it was remanded for further development. Entitlement to service connection for obstructive sleep apnea on a direct service connection basis and as caused by service-connected PTSD is remanded. Although the additional delay is regrettable, the Board finds another remand is required as there has not been substantial compliance with the January 2021 Board remand. In the January 2021 Board remand order, the Board directed the Agency of Original Jurisdiction to obtain an addendum opinion addressing the etiology of the Veteran's obstructive sleep apnea. Specifically, a VA examiner was asked to opine as to whether the Veteran's sleep apnea was related or attributable to his service, including his duties with a Fighter Squadron in Vietnam, and whether his obstructive sleep apnea was caused by his service-connected PTSD. In providing the requested opinions, the examiner was asked to address the Veteran's testimony that he was deprived of sleep during service and a medical study in the Journal of Clinical Sleep Medicine cited by the Veteran. In February 2021, a VA examiner opined that the Veteran's sleep apnea was not directly related to his service, noting that, while the Veteran may have had sleep issues during service, he was not diagnosed with sleep apnea until after service. The examiner also noted, "sleep issues are a wide variety of considerations with sleep apnea just being one." The examiner then opined that the Veteran's sleep apnea was not caused by his PTSD, noting that the Veteran had a BMI above 25 which is a majority cause of sleep apnea. In addition to finding the opinions inadequate as the examiner failed to provide an adequate rationale to support the opinions, the Board also finds the examiner did not address whether the Veteran's sleep apnea was related to his duties with a Fighter Squadron in Vietnam, or the medical study cited by the Veteran, as directed. Therefore, the Board finds remand is required to ensure substantial compliance with the Board's prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998) (holding that where the remand orders of the Board are not substantially complied with, the Board errs as a matter of law when it fails to ensure substantial compliance). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records for the period from May 2021 to the present. 2. After obtaining any additional records, obtain an addendum opinion from an appropriate clinician other than the February 2021 VA examiner. The Veteran's claims file should be made available to the examiner for review in conjunction with this request. The clinician is asked to provide opinions on the following questions: (a) Is it at least as likely as not that the Veteran's sleep apnea is related or attributable to his military service, to include his duties with a Fighter Squadron in Vietnam? (b) Is it at least as likely as not that the Veteran's service-connected PTSD caused the Veteran's sleep apnea? In providing the requested opinions, the examiner should address (i) the Veteran's testimony that he was deprived of sleep during his active service and (ii) the medical study in the Journal of Clinical Sleep Medicine cited by the Veteran. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Jiggetts 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.