Citation Nr: 21011681 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-13 703 DATE: March 2, 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 honorably in the United States Army from April 1968 to February 1970. The Veteran testified before the Board in May 2019 in a videoconference hearing. A transcript has been associated with the record. In October 2019, the Veteran’s appeal was remanded for further development. That development has since been completed. The Veteran contends that his current sleep apnea disability either had onset during service, is otherwise related to his service-connected PTSD. In January and February 2020, a VA examiner opined that the Veteran’s sleep apnea was less likely directly related to service, or secondary to PTSD. With respect to direct service connection, the examiner appeared to consider the Veteran’s reports of trouble sleeping, snoring and stopped breathing since his return from Vietnam, but in opining against a relationship to service, she simply noted that such symptoms can exist even in the absence of sleep apnea, and “such a history does not mean that sleep apnea was present at that time.” While this may be true, the opinion does not adequately discuss the nature and severity of this Veteran’s sleep apnea, and whether this Veteran’s symptoms may in fact be related to a longstanding condition. Without more explanation, the opinion lacks sufficient support. With respect to the potential relationship between the Veteran’s service-connected PTSD and sleep apnea, the examiner similarly did not include adequate rationale in support of her conclusion that the Veteran’s PTSD did not aggravate his sleep apnea. On remand, addendum opinions should be obtained. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from a clinician other than the examiner who provided the January and February 2020 medical opinions in this case. The claims file must be available to, and reviewed by the new clinician. Upon review of the record, the clinician should respond to the following: a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea had onset in, or is otherwise related to the Veteran’s period of service? In providing a response, please consider the Veteran’s reported history of symptoms, as well as the nature and severity of the Veteran’s sleep apnea disability. The examiner should discuss whether the current nature and severity of the Veteran’s disability is consistent with a finding that at least as likely as not had onset during service from 1968 to 1970. b) Notwithstanding the answer to the above question, is it at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea is caused or aggravated by his service-connected PTSD, or medications taken to treat the Veteran’s service-connected PTSD? The examiner should discuss both causation and aggravation, with consideration of the medical treatise evidence submitted by the Veteran during the appeal. All opinions should be supported by a medical explanation or rationale. If in the opinion of the reviewing clinician, answers to the questions above cannot be provided without an in-person or virtual examination or interview, such should be scheduled. 2. Then readjudicate the appeal. If the benefit sought remains denied, send the Veteran and his representative a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Hennessy, 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.