Citation Nr: 21011163 Decision Date: 03/01/21 Archive Date: 03/01/21 DOCKET NO. 15-32 575 DATE: March 1, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from January 1988 to February 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in August 2018. Entitlement to service connection for sleep apnea is remanded. Remand is necessary to obtain an additional VA medical opinion. First, the VA clinician must address the questions from the previous Remand directions. A November 2019 VA medical opinion determined that the Veteran’s obstructive sleep apnea was less likely than not proximately due to his service-connected disabilities, including asthma, because the Veteran’s obstructive sleep apnea was caused by “his post service ‘airway being sucked closed on inspiration during sleep’ and not asthma.” (quoting UpToDate). There is no discussion of whether the “airway being sucked closed” is secondary to asthma or another service-connected disability, however. It is simply a restatement of the mechanics of obstructive sleep apnea without explanation regarding potential causes. Thus, an opinion that addresses the etiology of the “airway being sucked closed on inspiration during sleep” is required. Moreover, a February 2020 VA medical opinion found no evidence that the Veteran’s obstructive sleep apnea (OSA) was aggravated beyond its natural progression by his service-connected asthma because “the OSA is corrected by CPAP usage.” The VA medical opinion did not explain how correction by CPAP usage ruled out asthma as an aggravating factor. Because adequate opinions were not provided regarding whether obstructive sleep apnea was proximately due to or aggravated beyond its natural progression by service-connected disabilities, a remand is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition, a recent decision by the United States Court of Appeals for Veterans Claims determined that obesity may be an intermediate step between a claimed condition and a service-connected disability where, among other circumstances, the record indicates that the Veteran’s mobility is limited or his physical activity is reduced as a result of a service-connected physical disability. Garner v. Tran, No. 18-5865, 2021 U.S. App. Vet. Claims LEXIS 81 (Vet. App. January 26, 2021). The February 2020 VA medical opinion indicated that the Veteran’s obstructive sleep apnea was “more likely than not [secondary to age/weight gain” after service, and some records link the Veteran’s service-connected gout and asthma with functional limitation and interference with exercise (e.g., July 2000 and March 2014 VA medical center (VAMC) records; January 2000 VA examination for bones; September 2009 VA examination for respiratory system). Thus, a VA opinion addressing whether the Veteran’s obesity is secondary to his service-connected disabilities is necessary. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding (a.) Whether the Veteran’s sleep apnea is at least as likely as caused or aggravated by a service-connected disability, including asthma. (b.) Whether the Veteran’s obesity is at least as likely as not caused or aggravated by service-connected disability or disabilities, including his cervical spine disability and gout. In other words, do service-connected disabilities impact the Veteran’s fitness and contribute to obesity? A full and complete rationale for all opinions expressed is required. 2. Then, readjudicate the claim on appeal. If the benefit sought remains denied, issue a supplemental statement of the case and, after appropriate time for response, return the case to the Board if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board W. Ripplinger, 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.