Citation Nr: 21005753 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 17-59 208 DATE: February 2, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1952 to March 1954. In an August 2019 decision, the Board denied the claim. The Veteran subsequently appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2020 order, the Court granted a Joint Motion for Remand (JMR), which vacated the Board’s decision and remanded the Veteran’s appeal to the Board for action consistent with the terms of the JMR. Entitlement to service connection for sleep apnea is remanded. The Board is unable to make an informed decision on the issue of service connection for sleep apnea, because the January 2019 VA medical opinion did not fully comply with the Board’s March 2018 remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). Although, the January 2019 VA examiner discussed some medications prescribed for the Veteran’s service-connected disabilities and whether any side effects cause or aggravate the Veteran’s rhinitis or sleep apnea, not all medications were addressed. In the July 2020 JMR, the parties noted that throughout the period on appeal, the Veteran was prescribed 21 medications, to include paroxetine. However, the examiner only addressed mirtazapine, Zoloft, Ambien, memantine, tramadol and gabapentin. The Board notes that paroxetine is a medication used to treat anxiety; the Veteran is service-connected for a psychiatric disorder. The medical opinion is inadequate and a new VA medical opinion must be obtained. The matters are REMANDED for the following action: Forward the claims file and copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion for the Veteran’s sleep apnea claim. After reviewing the record, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed sleep apnea was incurred in or is otherwise related to service? (b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed sleep apnea is proximately due to (caused by) the Veteran’s service-connected disabilities? (i) The examiner is asked to review the Veteran’s medical records and list all medications prescribed throughout the period on appeal and label whether the medications are prescribed for any service-connected disability. (ii) If any of the medications are prescribed to treat a service-connected disability, then determine whether any of the effects of the prescribed medication could cause or aggravate the Veteran’s sleep apnea condition. (c) If (b) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed sleep apnea has been aggravated by the Veteran’s service OR service-connected disabilities (to include any medications identified in item (ii) above)? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.