Citation Nr: 21008509 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 18-48 346 DATE: February 17, 2021 REMANDED Service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from December 1974 to April 1979 and in the U.S. Air Force from April 1982 to July 1994. This matter comes before the Board of Veterans Appeals (Board) from a December 2017 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Service connection for OSA was denied in an August 2019 Board decision. In September 2020 the United States Court of Appeals for Veterans Claims (CAVC) issued a Joint Motion for Remand (JMR) vacating the Board’s prior denial and remanding this matter for readjudication consistent with the JMR. The JMR stated that the Board erred in relying on inadequate VA medical examinations dated December 2017 and March 2019 when denying service connection for OSA and provided an inadequate statement of reasons or bases in violation of 38 U.S.C. § 7104(d)(1). The matters are REMANDED for the following action: 1. Obtain any relevant outstanding VA or private treatment records. 2. Obtain an in-person examination by a qualified clinician for an addendum VA medical opinion(s) which addresses the following: (a.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s OSA was incurred or is causally related to his active duty service? *In rendering this opinion, the clinician must specifically consider a 1974 service treatment record that reflects a complaint of difficult sleeping and the Veteran’s statements that he would stop breathing in his sleep during service and that those symptoms have persisted since that time. (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s OSA is proximately due to, or aggravated by, his service-connected disabilities (to include a nasal septum fracture, cervical spine arthritis, chondromalacia of the bilateral knees and sinus node dysfunction with pacemaker)? *With respect to the term “aggravation” in the context of a claim for secondary service connection, the examiner is advised that aggravation refers to any incremental increase in disability or any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions regardless of permanence. *In rendering these opinions, the clinician must specifically consider that the Veteran is on long-term opioid therapy to treat his service-connected disabilities and what impact this may have had on his development of OSA. (c.) Determine if the Veteran is overweight and, if so, what role that has to play in the development of his OSA. Likewise, if the Veteran is not overweight, that should be taken into consideration when the above opinions are provided. (d.) If the Veteran has obesity which is considered a causative factor of his OSA, then the examiner should determine whether the Veteran’s service-connected disabilities are an intermediate step between any service-connected disability and the OSA. The clinician should provide a complete rationale for all opinions expressed. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kyle McKone 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.