Citation Nr: 21010423 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 20-16 159 DATE: February 24, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from July 1979 to December 1984. This appeal comes before the Board of Veterans’ Appeals (Board) from a January 2019 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for sleep apnea, to include as secondary to PTSD, is remanded. The VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes that the veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). In this case, the Veteran claims entitlement to service connection for sleep apnea as secondary to PTSD. The Veteran was granted entitlement to service connection for PTSD in a September 2020 Board decision. The Veteran has been diagnosed with sleep apnea pursuant to a December 2018 VA treatment note. The Veteran, through his representative, submitted a statement along with his April 2020 substantive appeal, referencing a study published in the Journal of Clinical Sleep Medicine in relating the development of sleep apnea to Veteran’s suffering from PTSD. Furthermore, the Veteran was afforded a VA PTSD examination in April 2017, which reflects the Veteran’s PTSD is productive of such symptoms as chronic sleep impairment. The Veteran has a current diagnosed disability of sleep apnea, which he has claimed is secondary to a disability which has now been service-connected; and there is objective evidence which indicates the possibility that the two may be etiologically related. In light of the above, the Board finds that the low threshold under McLendon is met in this case and a VA medical opinion should be obtained to adequately decide the merits of the claim. McLendon, 20 Vet. App. at 83. The matters are REMANDED for the following action: Schedule the Veteran for a VA medical opinion from an appropriate treatment provider to assess the nature and etiology of his sleep apnea disability. If an in-person examination or telehealth interview is found to be necessary, such should be arranged. The VA examiner should review the Veteran’s entire claims file, including a copy of this Remand. Thereafter, the VA examiner should opine as to whether the Veteran’s sleep apnea is at least as likely as not (50 percent probability or greater) related to service. The examiner must also provide an opinion as to whether it is as least as likely as not that the Veteran’s sleep apnea was caused or aggravated by his service-connected PTSD. In so doing, the VA examiner must specifically consider the study referenced in the Veteran’s April 2020 substantive appeal published in the Journal of Clinical Sleep Medicine; as well as the medical evidence of record including the April 2017 VA PTSD examination showing that it is productive of chronic sleep impairment. The VA examiner should provide a rationale for all opinions expressed. If the examiner cannot provide an opinion without resorting to speculation, he or she must provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. Caroline Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G.C., 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.