Citation Nr: 21009034
Decision Date: 02/18/21	Archive Date: 02/18/21

DOCKET NO. 13-22 706
DATE: February 18, 2021

REMANDED

Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded.

REASONS FOR REMAND

The Veteran served on active duty from April 1985 to April 1988.

This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).  The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in February 2017.  A transcript of that hearing is of record.  This matter was remanded by the Board several times, most recently in April 2020.  

1. Entitlement to service connection for sleep apnea, to include as secondary to service-connected PTSD is remanded.

The Board cannot make a fully-informed decision on this issue because no VA examiner has opined whether the Veteran’s service-connected PTSD caused or aggravated his sleep apnea.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s sleep apnea is at least as likely as not (50 percent or greater probability) (i) proximately due to or (ii) aggravated by (defined as any increase in disability) the Veteran’s service-connected PTSD. Copies of all pertinent records must be made available to the examiner for review. 

The opinion offered must be supported by a complete rationale. The clinician is asked to address the contentions laid out in the January 2021 brief that chronic activation of stress hormones caused by PTSD is known to lead to a neural sensitization leading to upper airway dysfunction such as sleep apnea, and that psychotropic medications change patterns of brain activity and may directly and indirectly exacerbate sleep apnea and brain stimuli.  

 

 

M.E. Larkin

Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	A. Budd, 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 This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.