Citation Nr: 21005452 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 17-39 097 DATE: February 1, 2021 REMANDED Service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2007 to September 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing held before the undersigned Veterans Law Judge in July 2020. A transcript is of record. 1. Service connection for sleep apnea is remanded. The Veteran contends that his sleep disorder is secondary to his service-connected traumatic brain injury (TBI). See July 2017 VA Form-9. In June 2016, a VA examiner opined that it is less likely as not that the Veteran’s sleep apnea is secondary to his service-connected TBI. The examiner explained the limited studies on sleep apnea and TBI association have had methodology flaws and are only observational in nature that the Veteran’s sleep apnea cannot be attributed to or is secondary to his TBI. The examiner did not, however, address whether the Veteran’s sleep apnea was aggravated by his TBI. An addendum is needed in this regard. In addition to the above, the Board notes more evidence was added to the file after the June 2016 medical opinion. This evidence includes a medical treatise submitted by the Veteran in December 2016 titled, “Sleep Apnea in Adults with Traumatic Brain Injury: A Preliminary Investigation,” which discuss a correlation between sleep apnea and TBI. This evidence is pertinent to the appeal and should be considered by the VA examiner in formulating the requested medical opinion. During a VA TBI consult in May 2020, a clinician indicated that there is literature to show an increased risk of obstructive sleep apnea following TBI but did not otherwise elaborate or provide a clear nexus opinion based on the facts of this case. Additional VA records from June 2017 to May 2020, and from May 2020 to the present should be obtained. The matters are REMANDED for the following action: 1. Obtain any outstanding VA medical records from VA facilities, including Ann Arbor and Seattle VA medical centers, dated between September 2012 and April 2013. Also obtained updated VA medical records since June 2017. 2. Obtain an opinion from an appropriate clinician regarding whether it is at least as likely as not that the Veteran’s sleep apnea is either caused or aggravated by his service-connected TBI. Note: In answering this question, two opinions are required: one for proximate causation and a second for aggravation. In rendering the requested opinions, the examiner is to consider all pertinent medical and other objective evidence, to specifically include (1) the July 2020 hearing testimony in which the Veteran stated that his sleep disturbances began after the TBI, and (2) the medical treatise, “Sleep Apnea in Adults with Traumatic Brain Injury: A Preliminary Investigation,” submitted by the Veteran in December 2016. The examiner must discuss the underlying rationale for all opinions expressed, whether favorable or unfavorable. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jake Choi, Associate 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.