Citation Nr: 21011701 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 14-28 531A DATE: March 2, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1998 to November 2003. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Manchester, New Hampshire which among other things denied service connection for sleep apnea. The Veteran’s complete service treatment records are unavailable, as established in a May 2013 memorandum. Therefore, there is a heightened obligation to assist the Veteran in the development of his case, to explain findings and conclusions, and to consider carefully the benefit of the doubt rule. See O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). In April 2018, the Veteran’s claim was remanded by the Board in order to provide the Veteran a VA examination and to obtain medical opinions. The Veteran’s claim was again remanded by the Board in August 2020 to obtain an addendum opinion regarding aggravation. The Veteran’s claim must be remanded again because the December 2019 VA examiner, who provided a medical opinion regarding direct service connection, did not review all of the potentially relevant service records. This is indicated by the examiner’s description of the Veteran’s inservice medical history. He did not discuss a November 7, 2003 Navy substance abuse patient assessment that notes that the Veteran’s sleep was reported as erratic. (See September 23, 2013 Military Personnel Record). The December 2019 VA examiner stated in his opinion that the Veteran’s service records are silent for any sleep apnea conditions. Consequently, as the November 2003 record reflecting erratic sleep may be relevant to whether the Veteran’s sleep apnea manifested in service, a new opinion must be obtained that shows review of all the relevant inservice documents that discuss the Veteran’s sleep condition. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide an examination, it must provide an adequate one). The December 2019 VA examiner also stated that the Veteran’s file does not contain the Veteran’s service entrance examination. That is incorrect, as the Veteran’s September 28, 1998 service entrance examination is of record. (See July 8, 2013 Caseflow entry labelled Military Personnel Record). The new medical opinion should note review of the September 28, 1998 service entrance examination. Additionally, the new medical opinion should discuss a July 18, 2012 Brockton Neighborhood Health Center record in which the Veteran reported having had fatigue and insomnia for the past ten years, a history which extends back to his period of active service. The matters are REMANDED for the following action: Forward the record and a copy of this remand to the examiner who conducted the December 2019 VA examination, or if the examiner is unavailable, another suitably qualified examiner, for completion of an addendum opinion. If the examiner determines that another in-person examination of the Veteran is required to provide the below-requested information, then such an examination should be scheduled. Following review of the record, the examiner should express an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s current sleep apnea is related to or had its onset during his military service. The examiner is asked to provide a rationale for his/her opinion and is in particular asked to discuss the September 1998 service entry examination report, the October 2003 separation examination report, and the November 7, 2003 Navy substance abuse patient assessment that refers to erratic sleep. The examiner is also asked to discuss a July 18, 2012 Brockton Neighborhood Health Center record in which the Veteran reported having had fatigue and insomnia for the past 10 years. J. Rutkin Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. E. Jones, 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.