Citation Nr: 21008426 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 20-04 600 DATE: February 17, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as due to posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1964 until October 1966. This matter was most recently before the Board in November 2020 when it was remanded for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for obstructive sleep apnea, to include as due to PTSD is remanded. The claim must be remanded again because the December 2020 VA medical opinion is inadequate. Although, the VA examiner discussed a specific journal article submitted by the Veteran suggesting an association between sleep apnea and PTSD, the examiner opined that the article was not relevant to this Veteran because the article dealt mainly with younger Veterans who served in the Persian Gulf War. In the opinion, the examiner appears to disregard the Veteran’s contention that a nexus may exist between his sleep apnea and PTSD and further discounts the study because of diagnostic criteria for PTSD used. Additionally, the examiner does not appear to consider or discuss the existence of a multiple other studies that also suggest an association between PTSD and sleep apnea; to include an additional journal article submitted by the Veteran in December 2020 stating that “there is growing evidence that this population [PTSD Veterans] also suffers from obstructive sleep apnea... more often than the general population.” On remand, a new VA medical opinion should be obtained to allow for the examiner to review and discuss the medical literature that sleep apnea is associated with PTSD and how that may or may not relate to this Veteran’s claim. The matters are REMANDED for the following action: Forward the claims file and copies of all pertinent records to an appropriate VA examiner that is different that the December 2020 VA examiner (if possible), to obtain an opinion on the likely etiology of the Veteran’s sleep apnea. If the examiner determines that an opinion cannot be provided without an examination (or telehealth interview) one should be scheduled. The examiner is asked to answer the following questions: (a) Is it as least as likely as not (50 percent or greater probability) the Veteran’s sleep apnea is proximately caused by the Veteran’s service-connected PTSD? (b) If the answer to (a) is now, is it as least as likely as not (50 percent or greater probability) the Veteran’s sleep apnea is aggravated by (defined as any increase in disability) the Veteran’s service-connected PTSD? In answering these questions, the examiner must review and discuss (i) any medical literature and studies that address sleep apnea as it relates PTSD, and (ii) peer review research article from 2016, submitted by the Veteran in December 2020, found on VA’s PTSD Research Quarterly website, titled PTSD and Sleep, by Philip Gehrman, Ph.D., et al. (https://www.ptsd.va. gov/publications/rq_docs/V27N4.pdf). 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, 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.