Citation Nr: 21008920 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 15-10 862 DATE: February 18, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from November 1971 to November 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision by the Salt Lake City, Utah, Regional Office (RO) of the Department of Veterans Affairs (VA). In November 2015, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. The transcript of that hearing is of record. The issue on appeal was remanded for additional development in June 2018 and July 2020. The July 2020 remand sought to reconcile conflicting evidence as to whether an etiological relationship existed between the Veteran’s obstructive sleep apnea and his service-connected posttraumatic stress disorder (PTSD). An October 2020 VA medical opinion was obtained addressing this specific question and found it was less likely his sleep apnea was proximately due to or the result of his PTSD. This negative finding was based on the determination that symptoms of sleep apnea were reported as having begun in 1972 and that records did not indicate a diagnosis of PTSD at that time. However, in addressing the question of aggravation, the examiner merely stated that there was no evidence to support a finding that the sleep apnea was aggravated by PTSD. No rationale was given. The examiner also failed to address the presented question, which was the sleep apnea underwent any incremental increase in disability, regardless of permanence due to the PTSD. There was also an inadequate discussion on the question of direct service connection. The negative conclusions made in October 2020 VA were based on the finding that the symptoms of sleep apnea had their onset in 1972, which was many years prior to the PTSD diagnosis. Such suggests that the sleep apnea was incurred during active service, which would be consistent with statements made by the Veteran’s spouse in November 2015. However, the record includes a July 2019 VA medical opinion that specifically found it was less likely his sleep apnea was related to an in-service injury, event, or disease. In fact, the July 2019 examiner found “[m]orbid obesity is far and away the MOST likely cause of this [V]eteran’s [obstructive sleep apnea].” In light of the conflicting medical evidence of record, the Board finds an additional medical opinion is required. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s sleep apnea at least as likely as not: i. had its initial onset in service or is otherwise etiologically related to the Veteran’s active service? ii. is proximately due to a service-connected disability? iii. underwent any incremental increase in disability, regardless of its permanence, due to a service-connected disability? The term “incremental increase in disability” means additional impairment of earning capacity. Objective measurement, or numerical quantification, is not required to ascertain an increase in disability. Moreover, any “incremental increase in disability” need not be permanent. Provide a rationale to support the opinions. In so doing, the examiner is asked to acknowledge review of the pertinent evidence of record, including the July 2019 private medical opinion, VA medical opinions in July 2019, February 2020, and November 2020, the testimony and lay statement provided in November 2015, the medical literature provided in November 2015, and other literature referenced in the July 2019 private medical opinion and a February 2020 VA medical opinion. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Douglas 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.