Citation Nr: 21012106 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 16-04 765 DATE: March 3, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as due to posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1977 to September 1994. This case is before the Board of Veterans’ Appeals (Board) on appeal from a November 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office. In November 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the electronic claims file. In April 2019, the Board reopened the Veteran’s service connection claim for sleep apnea and remanded the matter for more development. The matter was remanded again in October 2020 for additional development. Now the matter is returned to the Board. The Veteran is seeking service connection for sleep apnea, to include as due to his service-connected PTSD. Unfortunately, the Board finds that another remand is required prior to final adjudication of the matter. The Board notes that a medical opinion by a VA examiner was obtained in December 2020 following the Board’s Remand in October 2020. The December 2020 VA examiner opined that it is less likely than not that the Veteran’s obstructive sleep apnea is due to or has been aggravated by PTSD and provided a rationale for the opinion. However, the Board notes that the examiner failed to discuss the Veteran’s assertions and the referenced medical article in the September 2020 appellate brief as instructed in the October 2020 Board remand directives. Thus, the Board finds that there has not been a substantial compliance with the Board’s previous remand order, and an addendum opinion is necessary in order to make a fully informed decision on the matter. Stegall v. West, 11 Vet. App. 268, 271 (1998) Accordingly, the matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction must obtain an addendum opinion from the December 2020 VA examiner regarding the Veteran’s service connection claim for sleep apnea. If the December 2020 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. The examiner should review the Veteran’s claims file and a copy of this REMAND order before rendering the requested addendum opinion. (a.) The examiner must opine whether the Veteran’s current obstructive sleep apnea is at least as likely as not (50 percent or greater probability) caused by or proximately due to his service-connected PTSD. (b.) Also, the examiner must opine whether the Veteran’s current obstructive sleep apnea is at least as likely as not (50 percent or greater probability) aggravated beyond its natural progression by his service-connected PTSD. (c.) The examiner is specifically asked to address the Veteran’s assertions and referenced medical article in the September 2020 appellate brief. See September 18, 2020 Appellant’s Post-Remand Brief (the Veteran included a reference to a study entitled Obstructive Sleep Apnea and PTSD among OEF/OIF/OND Veterans published in the Journal of Clinical Sleep Medicine, available at http://dx.doi.org/10.5664/jcsm.4692). (d.) The examiner must provide a complete written rationale for any opinion offered. If the examiner cannot provide an opinion, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond based on given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. 2. After completing the above actions and any other necessary development, the issue on appeal must be readjudicated. If the claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to   respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. E. Kim, 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.