Citation Nr: 21008919 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 16-21 347 DATE: February 18, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. Entitlement to service connection for a heart disorder, to include as due to claimed OSA, is remanded. REASONS FOR REMAND The Veteran has verified active duty service from January 1979 to December 1994. This matter comes before the Board of Veterans’ Appeals (Board) from a September 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge. During the hearing, the Veteran was provided 60 days to submit additional evidence. While the Veteran and his representative submitted some lay evidence, they did not submit medical treatment records from sources discussed at the hearing, to include Madigan Army Medical Center and updated medical records from VA. Although the Board regrets further delay, a remand is necessary to obtain all available medical treatment records and medical opinions. During the August 2012 VA examination for OSA, the examiner opined that the Veteran’s obesity was more likely than not the higher risk factor for the Veteran’s development of OSA. The examiner also opined that those who suffer from OSA tend to fall asleep with ease, which is contrary to the assertion made by the Veteran regarding his ability to fall asleep. However, various lay statements submitted by the Veteran’s family members in May 2019 show that the Veteran generally struggled to stay awake and would fall asleep immediately, snoring and bobbing his head during the time he was in service. In light of these new facts, an addendum opinion is necessary regarding the etiology and nature of the Veteran’s claimed OSA. The Veteran testified to disciplinary action being taken against him for falling asleep at his desk while he was in Germany in the 1980’s. His service personnel record should be obtained. During the May 2019 hearing, the Veteran and his representative asserted that the difficulty with sleep and the medical treatments associated with his sleep difficulties during service caused or aggravated his heart condition and testified to having been treated for heart conditions, to include chest pain and palpitations. In order to fully address the Veteran’s claimed theory of entitlement as well as all instances of treatment during service, the Board finds that another VA opinion is required. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. Obtain the Veteran’s full service personnel record. 2. Ask the Veteran to identify all outstanding treatment records relevant to his OSA and heart disability claims, to include information about treatment at Madigan Army Medical Center. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of the unavailability of the records. 3. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current OSA onset during service or is otherwise related to an in-service injury, event, or disease. In offering the opinion, the examiner is asked to consider the May 2019 lay statements about observed in-service symptoms. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. 4. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current heart disability onset during service or is otherwise related to an in-service injury, event, or disease, to include service treatment records showing complaints of chest pain around February 1988 and January 1993. The Veteran also testified to treatment for heart palpitations during service. EKGs were performed in February 1988, December 1992, and January 1994. The Veteran further testified that he believed his heart disability may be related to sleeping pills he took during service. The examiner should also address whether any current heart disability is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) the Veteran’s OSA and resulting difficulty with sleep. The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. J. Kim, 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.