Citation Nr: 21009394 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 18-26 007 DATE: February 22, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1956 to August 1960. In November 2020, the Board remanded this case for additional development. The Board finds that there has not been substantial compliance with the Board’s previous remand directives. Remand for further development is required. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. The Veteran asserts that OSA is the result of service-connected PTSD. The November 2020 Board remand noted that the Veteran submitted two articles showing a correlation between PTSD and OSA. Specifically, the articles suggested that those who have PTSD are at higher risk for developing OSA. The Board remanded the claim for a VA examination to address the articles and provide a medical opinion on whether OSA was related to service, secondary to service-connected PTSD, aggravated by service-connected PTSD. An opinion was provided in November 2020. The Board finds the November 2020 opinion incomplete for adjudication purposes. The examiner opined that “given that the Veteran was not diagnosed until well after separation, it is less likely that the Veteran’s OSA is proximately due to or the result of service-connected PTSD.” It is not clear if the opinion is regarding direct service connection or secondary service connection. The examiner did not provide an opinion on direct and secondary service connection, or aggravation. The examiner stated that “the etiology of OSA is clear and noted below…” However, the examiner did not provide an etiology for OSA. Inasmuch as the examiner concluded that OSA is not the result of service because OSA was diagnosed years after separation, the Board notes that an opinion based on the absence of medical records without consideration of a Veteran's lay statements is incomplete. Buchannan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Moreover, the examiner’s opinion did not address the articles provided by the Veteran. The examiner stated that “the Veteran ha[d] a number of health condition[s] effecting the quality of his sleep.” However, there is no discussion as to why the other conditions were more likely the cause of OSA. The Board notes that the Veteran’s asserts that OSA is related to PTSD and has submitted articles supporting the contention. The examiner is not required to accept the Veteran's theory. However, the examiner must fully explain any disagreement with the Veteran's theory of causation, and provide a discussion of the relevant or significant medical history, clinical findings, medical knowledge or literature, and other factors that support negative medical opinion or conclusions. The Board notes that remand confers on the Veteran the right to compliance with the terms of that remand. Stegall v. West, 11 Vet. App. 268 (1998). Therefore, remand is necessary to ensure compliance with the Board's previous remand directives. The examiner stated that it was “less likely that those Veteran's with PTSD caused his OSA or aggravated his severity beyond the natural progression of the OSA disorder by his service-connected PTSD. While both PTSD and OSA have the potential of disturbing sleep there is no evidence to establish a base line measurement of disturbance sleep problems/symptoms as they may relate to the other medical condition the Veteran's records document.” The Board finds the rationale for the opinion incomplete. The rationale does not explain why OSA is not aggravated by PTSD. Instead, the rationale discusses the issue of baseline, which is relevant only if aggravation is found. When VA provides an examination or obtains an opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Remand for a VA examination is necessary. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to determine the etiology of OSA. The examiner must review the claims file, address the medical articles submitted by the Veteran suggesting that those with PTSD have a higher risk of developing OSA, and consider the Veteran’s lay statements. The examiner must opine whether: (a.) It is at least as likely as not (50 percent probability or greater) that the Veteran’s OSA is related to service or any event, injury, or disease in service? The examiner should discuss the Veteran’s lay statements regarding onset of symptomatology and symptoms during and since service. (b.) It is at least as likely as not (50 percent probability or greater) that the Veteran’s OSA is proximately due to or the result of service-connected PTSD? The examiner must consider and discuss the articles submitted by the Veteran finding that those with PTSD are at higher risk of developing OSA. (c.) It is at least as likely as not (50 percent probability or greater) that the Veteran’s OSA has been aggravated (increased in severity beyond the natural progress of the disorder) by service-connected PTSD? Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.