Citation Nr: 21077019 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 18-45 511 DATE: December 28, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected other specified trauma and stressor related disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1968 to July 1970. On appeal is a September 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) that denied service connection for sleep apnea. A virtual Board hearing was held in this matter in June 2021 before the undersigned Veterans Law Judge, and a transcript of the proceedings is associated with the claims file. This matter was previously before the Board of Veterans' Appeals (Board) in August 2021 when the Board remanded for further development. The matter has now returned to the Board for appellate review. Entitlement to service connection for sleep apnea, to include as secondary to service-connected other specified trauma and stressor related disorder, is remanded. The Board regrets any further delay in this matter, but finds additional development is required. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, the Veteran's case was remanded for a medical opinion to assess the nature and etiology of his claimed sleep apnea, to include as secondary to service-connected other specified trauma and stressor related disorder. In the August 2021 Remand, the Board gave specific remand directives, stating the examiner must offer an opinion as to whether it is at least as likely as not that the Veteran's sleep apnea began in service, within one year of service separation, or is otherwise related to his service; was caused by his service-connected other specified trauma and stressor related disorder; or has been aggravated by his service-connected other specified trauma and stressor related disorder. In addition, the Board stated the examiner must consider and specifically comment on the Veteran's in-service complaint of "feeling sleepy all the time"; the lay statements from the Veteran and his spouse; and the articles submitted by the Veteran that suggest a link between sleep apnea and mental health issues. Lastly, the Board stated that the examiner must provide a complete rationale for all opinions and conclusions expressed. If the examiner rejects the Veteran's reports, the examiner should provide a rationale for doing so. A new medical opinion was obtained in October 2021. Although the examiner rendered a negative opinion, the examiner did not adhere to all of the Board's remand directives. First, the medical opinion did not provide a rationale for the opinion that the Veteran's sleep apnea was not aggravated by his service-connected other specified trauma and stressor related disorder. Second, the examiner did not provide a rationale for rejecting the Veteran's reports, or the reports of his wife, of the Veteran having symptoms of sleep apnea since service. Although the examiner stated in her written report that she read the statements submitted by the Veteran and his wife, she opined only that "the Veteran was diagnosed with sleep apnea in 2006 ... which demonstrates a lack of chronicity of care." A remand by the Board confers on the claimant a legal right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). A failure by the Board to ensure that its remand orders are complied with constitutes legal error. Id. On remand, new medical opinions that address all of the Board's remand directives must be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from a qualified examiner other than the examiner who provided the October 2021 opinion regarding the etiology of the Veteran's sleep apnea. If the examiner determines the Veteran should be given another examination (including via telehealth if an in-person examination is not possible) to answer the below questions, one should be scheduled. The examiner must offer an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea: Began in service, within one year of service separation, or is otherwise related to his service; Was caused by his service-connected other specified trauma and stressor related disorder; or Has been aggravated by his service-connected other specified trauma and stressor related disorder. In rendering a decision, the examiner must specifically consider and thoroughly discuss: the in-service complaint of "feeling sleepy all the time;" the lay statements from the Veteran and his spouse; and, the articles submitted by the Veteran that suggest a link between sleep apnea and mental health issues. A complete rationale must be given for all opinions and conclusions expressed. The examiner is advised that the Veteran is competent to report history and symptoms, and that his reports must be considered in the requested opinion. If the examiner rejects the Veteran's reports, the examiner should provide a rationale for doing so. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jiggetts, Tenisha 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.