Citation Nr: 21008390 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 17-17 192A DATE: February 16, 2021 REMANDED Entitlement to service connection for sleep apnea (also claimed as sleep disturbances) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1985 to June 1989 and from December 1990 to May 1991, to include service in the Southwest Asia Theater of operations during the Persian Gulf War. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in May 2020. A transcript is of record. Entitlement to service connection for sleep apnea In an August 2016 VA examination report, the examiner concluded that the Veteran did not have a current diagnosis of sleep apnea. However, in so finding, he stated that the Veteran’s private treatment records were unavailable for review. Notably, a May 2012 private sleep study report showed an impression of moderate obstructive sleep apnea. In support of his claim, the Veteran submitted a November 2016 private treatment record that noted his sleep apnea was most likely related to the effects of his military service and weight gain. However, no supporting rationale was provided for the opinion. A medical opinion must support its conclusions with analysis. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In a March 2017 VA medical opinion, the examiner opined that the Veteran’s obstructive sleep apnea was less likely than not incurred in or cause by his active duty military service. The examiner also opined that it was less likely than not that the available objective medical evidence could support the Veteran’s subjective claim of sleep apnea during military service or that it was related to Gulf War environmental exposures. The Board notes that the March 2017 examiner provided no supporting rationale for his opinion regarding in-service environmental exposures. In addition, in rendering his opinion, the examiner stated that sinusitis is a comorbid condition that contributes to snoring and could partially explain the lay statement from the Veteran’s spouse regarding his symptoms. However, the examiner’s supporting rationale regarding the Veteran’s comorbid condition is speculative in nature and does not adequately address the lay statements of record. Therefore, the Board finds that a remand is necessary to obtain an additional medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide a medical examination or opinion, it must ensure that the examination or opinion is adequate). Lastly, during the May 2020 Board hearing, the Veteran testified that he received treatment and underwent testing for sleep apnea at private facilities as early as 1997. See May 2020 Board Hearing Transcript, at 6-7. However, the private treatment records that are currently associated with the claims file appear to be limited to records dated since 2011. Therefore, on remand, the Agency of Original Jurisdiction (AOJ) should attempt to obtain any outstanding private treatment records. The matters are REMANDED for the following action: 1. Ask the Veteran to identify and provide complete authorization to obtain any outstanding, relevant private medical records regarding his sleep apnea, including records from the St. Mark’s Hospital and the University of Utah Health Care Center identified during the May 2020 Board hearing. After securing the necessary authorization, these records should be requested. If any records are not available, the Veteran should be notified. 2. Schedule the Veteran for a VA examination by an appropriate examiner to determine the nature and etiology of the Veteran’s sleep apnea (also claimed as sleep disturbances). Any and all studies, tests, and evaluations deemed necessary should be performed. (a) The examiner should opine as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s sleep apnea manifested in or is otherwise causally or etiologically related to active service, to include any exposure to environmental hazards. (b) If the examiner determines that the Veteran has any symptomatology that is not attributable to a diagnosed disorder of conclusive pathophysiology or etiology, the examiner should state whether the Veteran has objective indications of a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multisymptom illness, as established by history, physical examination, and laboratory tests. If so, the examiner should also report all signs and symptoms necessary for evaluating the illness under the rating criteria. In providing this opinion, the examiner should take as fact that the Veteran suffered from loud snoring and daytime fatigue during service. The examiner should also consider: (1) the Veteran’s private treatment records that document diagnoses of sleep apnea (see, e.g., November 2013 private treatment record and May 2012 private sleep study report) and (2) the lay statements from the Veteran and his spouse regarding his symptoms of snoring and breathing difficulties since service (see, e.g., December 2016 Correspondence and May 2020 Board Hearing Transcript). A complete rationale for any opinion offered should be provided. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Wulff, 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.