Citation Nr: 21077381 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 18-41 944 DATE: December 29, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as due to in-service herbicide exposure, in-service environmental exposures (asbestos, hydrogen sulfide gas, crank case oil, petroleum, soot, stack smoke, fumes, jet exhaust, and aviation fuel), and/or as secondary to service-connected disabilities (including depression, tinnitus, coronary artery disease (CAD), and diabetes mellitus), is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1963 to March 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in December 2017 and March 2018. In March 2021, the Veteran testified at a Board Central Office hearing before the undersigned Veterans Law Judge in Washington, DC. A transcript of the hearing is of record. In May 2021 and September 2021, the Board remanded this matter for additional development. Entitlement to service connection for OSA is remanded. Unfortunately, multiple VA examination reports/medical opinions of record simply do not address some of the Veteran's asserted theories and contentions regarding his claimed OSA. For instance, an April 2020 AOJ memorandum showed that the Veteran's exposure to herbicides was conceded based on his nautical service. The Veteran has asserted that his claimed OSA was related to in-service herbicide exposure as well as caused or aggravated by additional service-connected disabilities, including bilateral tinnitus, CAD, and diabetes mellitus. In light of the cumulative record, the Board will not decide the appeal until a competent VA medical opinion is provided in order to fully address the Veteran's multiple contentions and clarify the etiology of his claimed OSA on appeal. The matter is REMANDED for the following actions: 1. Obtain a VA medical opinion to clarify the etiology of the Veteran's claimed OSA from an appropriate examiner. If an opinion cannot be provided without an examination, one should be provided. The electronic claims file and a copy of this REMAND must be made available to the examiner, and the examiner must specify in the report that the file has been reviewed. Based on a review of the electronic claims file and the Veteran's lay assertions, the examiner must provide an opinion as to whether the Veteran's OSA was at least as likely as not (50 percent or greater probability) causally related to his active military service, to include conceded in-service asbestos and herbicide exposures, asserted in-service sleep deprivation, and asserted in-service chemical exposures (to include hydrogen sulfide gas, crank case oil, petroleum, soot, stack smoke, fumes, jet exhaust, and aviation fuel). The examiner should also provide an opinion as to whether the Veteran's OSA was at least as likely as not (50 percent or greater probability) caused or aggravated (worsened) by his service-connected bilateral tinnitus, CAD, diabetes mellitus, or depression (to include medications taken to treat it). The examiner is advised that permanent worsening of the condition beyond its natural progression need not be shown. The possibility of temporary worsening should be addressed. Aggravation refers to any incremental increase in disability, any additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence. The examiner should acknowledge and discuss the Veteran's lay assertions, lay statements from family members that he has snored since 1968, findings in the March 2018, May 2019, June 2021, and October 2021 VA examination reports/medical opinions, multiple pieces of relevant treatise evidence submitted by the Veteran, and the September 2020 private medical opinion, reconciling those lay assertions and medical findings with the examiner's current opinion. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). The Veteran is hereby advised that failure to report for any scheduled VA examination without good cause shown may have adverse effects on his claim. 38 C.F.R. § 3.655. 2. After completing the above action and any other necessary development, the claim on appeal must be re- adjudicated, taking into consideration all relevant evidence associated with the record since the October 2021 SSOC. If the benefit on appeal remains denied, an SSOC must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. D. Deane, 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.