Citation Nr: 21008953 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 14-30 031 DATE: February 18, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1980 until September 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision of the Department of Veterans Affairs (VA) regional office (RO). This matter was previously before the Board in July 2018. In this decision, the Board reopened the claim and remanded it for further development, namely, to obtain a VA examination regarding whether the Veteran’s sleep apnea was directly related to service. The claim now returns to the Board. Entitlement to service connection for obstructive sleep apnea is remanded. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate.  Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).  A medical opinion is considered adequate “where it is based on consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one.” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007).    The Veteran participated in a May 2014 VA examination. Therein, the VA examiner stated that there was no diagnosis of sleep apnea. However, the Veteran submitted a private sleep study in August 2014 in which he was diagnosed with sleep apnea. In January 2017, a VA examiner provided an addendum opinion in which he found that the Veteran’s sleep apnea was less likely than not related to his service-connected hypertension because the medical science does not support that hypertension causes or aggravates sleep apnea. This VA examiner did not provide an opinion regarding direct service connection. Pursuant to the Board’s July 2018 remand, in July 2020, a VA examiner provided an addendum opinion in which she found that the Veteran’s sleep apnea less likely than not onset in service or is etiologically related to service. The VA examiner reasoned that there were no complaints of sleep problems in the Veteran’s service treatment records; she did not specifically discuss the Veteran’s lay contentions that his sleep apnea symptoms, such as “snoring loud and stop breathing,” started in the military and continued thereafter. In November 2020, the Veteran contended that his service-connected disabilities have caused his weight gain, and that his weight gain is a cause or contributing factor of his sleep apnea. The Board notes that October 2010 VA treatment records indicate that the Veteran is obese due to, among other things, his service-connected hypertension and August 2019 VA treatment records show that the Veteran’s obesity is a potential cause of his sleep apnea. Unfortunately, the Board must remand for another addendum opinion. First, the Board finds the July 2020 VA examination inadequate as the examiner failed to specifically discuss the Veteran’s numerous lay contentions regarding the onset of his sleep apnea in service.   Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Secondly, an addendum VA opinion is necessary to obtain an opinion as to what extent, if any, the Veteran’s service-connected disabilities contributed to his obstructive sleep apnea through the intermediate step of causing his obesity. See VAOPGCPREC 1-2017 (January 6, 2017);Walsh v. Wilkie, 32 Vet. App. 300 (2020) (holding that obesity as an “intermediate step” in a causal chain for service connection can be established on either a causal or aggravation basis). The matters are REMANDED for the following action: 1. Obtain any outstanding private or VA treatment records and associate them with the claims file. 2. Thereafter, obtain an addendum VA medical opinion to determine the nature and etiology of the Veteran’s sleep apnea. If an additional VA examination (or telehealth interview or similar action, if an in-person examination is not feasible) is deemed necessary, then one should be scheduled.  The claims folder, to include a copy of this remand, must be reviewed in conjunction with the examination and opinion. The examiner is asked to provide separate, well-reasoned responses to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea onset in service or is otherwise directly related to service? The VA examiner must specifically address the Veteran’s lay contention that his sleep apnea started in service. (b) Is it at least as likely as not (50 percent or greater probability) that a service-connected disability caused the Veteran to become obese? i. If yes, was the obesity a substantial factor in causing or aggravating the Veteran's sleep apnea? ii. If yes, would sleep apnea not have occurred but for the obesity caused by the Veteran's service-connected disability? The examiner is reminded that the Veteran is currently service-connected for (1) major depressive disorder, (2) nephrosclerosis, (3) hypertensive heart disease, (4) migraine headaches, (5) lumbar spine degenerative disc disease, (6) right ankle arthritis, (7) tinnitus, (8) right knee patellofemoral pain syndrome, (9) hypertension, and (10) right hear hearing loss. In providing the above opinion, the examiner is asked to comment on the October 2010 and August 2019 VA treatment records. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Finelli, 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.