Citation Nr: 21010387 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 14-35 292A DATE: February 24, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1981 to May 2002. This matter comes before the Board of Veterans’ Appeals (Board) from an April 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran’s spouse and designated payee testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The case was last before the Board in July 2020 and has returned to the Board for further appellate review. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c). 1. Entitlement to service connection for sleep apnea is remanded. In July 2020, the Board remanded the claim to obtain a medical opinion with respect to whether the Veteran’s sleep apnea was caused or aggravated by his service-connected traumatic brain injury (TBI) with neurocognitive disorder. The Board instructed that the examiner’s opinion should reflect consideration of the article cited by the Veteran’s representative entitled “Traumatic Brain Injury and Sleep Disorders.” In November 2020, a VA examiner opined that it was less likely than not that the Veteran’s sleep apnea was caused or aggravated by his service-connected TBI. The examiner noted that the Veteran was diagnosed with sleep apnea in 2013 and TBI was not diagnosed until 2019. However, the examiner did not sufficiently explain the basis for the conclusion reached, nor does the opinion reflect consideration of cited article. Accordingly, the claim is remanded in order to obtain another medical opinion in compliance with the terms of the Board’s prior remand instructions. See Stegall v. West,11 Vet. App. 268, 271(1998). The Board also finds that an additional an addendum opinion is needed with respect to whether the Veteran’s sleep apnea was caused or aggravated by his weight gain caused by his service-connected disabilities and/or medication prescribed to treat service-connected disabilities. In rendering a negative secondary service connection opinion, the November 2020 examiner explained that sleep apnea is characterized by repetitive collapse of the upper airway during sleep, and while certain risk factors including obesity have been associated with obstructive sleep apnea, it is not established that obesity is a cause of obstructive sleep apnea. Additionally, the examiner explained that causative links between medications and sleep apnea have not been established. However, the examiner did not sufficiently address whether the Veteran’s sleep apnea was caused or aggravated by weight gain caused by his service-connected disabilities and/or medications prescribed to treat those disabilities. See Walsh v. Wilkie, 32 Vet. App. 300, 306-07 (2020) (service connection may be established on a secondary basis for a disability which would not have occurred but for obesity that was caused or aggravated by a service-connected disability). Thus, a VA addendum opinion is needed. The matters are REMANDED for the following action: 1. Provide the claims file to an appropriate VA examiner to obtain in opinion with respect to the Veteran’s claim for service connection for sleep apnea. After a review of the claims file, the examiner should respond to the following: (a.) Whether it is at least as likely as not (50 percent or higher probability) the Veteran’s sleep apnea caused by his service-connected traumatic brain injury with neurocognitive disorder? (b.) Whether it is at least as likely as not (50 percent or higher probability) the Veteran’s sleep apnea was aggravated (worsened beyond natural progression) by his service-connected traumatic brain injury with neurocognitive disorder? In rendering the above opinions, the examiner must consider and discuss the article cited by the Veteran’s representative entitled “Traumatic Brain Injury and Sleep Disorders.” (VBMS –Appellate Brief, received 5/26/20). (c.) Whether it is at least as likely as not (50 percent or higher probability) that the Veteran’s sleep apnea was caused by weight gain caused by service-connected disabilities and/or medications prescribed to treat service-connected disabilities? (d.) Whether it is at least as likely as not (50 percent or higher probability) that the Veteran’s sleep apnea was aggravated (worsened beyond natural progression) by weight gain caused by service-connected disabilities and/or medications prescribed to treat service-connected disabilities? The examiner is advised that the Veteran is service-connected for traumatic brain injury with neurocognitive disorder, an undiagnosed illness manifested by fatigue, unspecified trauma and stressor related disorder, migraine headaches, hearing loss, tinnitus, irritable bowel syndrome, and nasoseptal deviation with allergic rhinitis. A complete rationale for all opinions must be provided. 2. If the claim remains denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lance, 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.