Citation Nr: 21012501 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 15-28 528 DATE: March 4, 2021 REMANDED Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a right shoulder disability is remanded. The Veteran asserts that he is entitled to service connection for a right shoulder disability because a right shoulder disability was aggravated by service. The Agency of Original Jurisdiction has determined that a right shoulder disability pre-existed entrance to service. The service medical records show complaints and treatment for right shoulder pain. At a July 2018 Board hearing, the Veteran testified that his right shoulder disability worsened while in active service. Following training, he stated that he started experiencing soreness and various problems. The Veteran asserted that following a right shoulder surgery prior to service, he did not experience any additional problems. However, after lifting and carrying in service, he began to experience pain. In an August 2013 VA examination, the examiner opined that the right shoulder disability, which clearly and unmistakably existed prior to service, was not aggravated beyond the natural progression by service. The examiner noted a February 2012 right shoulder x-ray showed mild acromioclavicular joint degenerative changes and an August 2012 note documented complaints of right shoulder pain after rollover training in June. The examiner stated that documented degenerative changes were an expected sequelae status after right shoulder arthroscopic surgery. When VA obtains an examination or opinion, the examination or opinion must be adequate.  Barr v. Nicholson, 21 Vet. App. 303 (2007). The August 2013 VA examiner did not address the Veteran’s reports of increased pain and soreness in the right shoulder following enlistment in-service. The examiner’s opinion that “degenerative changes are expected” also did not address if the changes were worse than they would have been if not for service. Therefore, additional VA examination is necessary. 2. Entitlement to service connection for OSA is remanded. The Veteran asserts that he is entitled to service connection for OSA because the claimed disability was caused by service-connected depression. More specifically, he asserts that depression led to weight gain as it caused a “lack of interest into doing any kind of physical exercise” and that weight gain caused OSA. In July 2017 a VA examiner opined that the Veteran’s OSA was less likely than not proximately due to or the result of depressive disorder medication with weight gain. The examiner explained that OSA was caused by narrowing of the airway that prevented normal breathing during sleep. There is no evidence that a psychological condition such as depressive disorder caused airway narrowing. In reference to the contention that depression medication caused weight gain, the examiner explained that medical literature attributed obesity to genetic factors. The examiner also provided a negative opinion on the relationship between OSA and a service-connected left shoulder disability. Essentially, the examiner attributed the obesity to genetics, not medication. When VA obtains an examination or opinion, the examination or opinion must be adequate.  Barr v. Nicholson, 21 Vet. App. 303 (2007). The July 2017 examiner did not provide an opinion as to whether OSA was aggravated by service-connected depression. Because of the Veteran’s statements regarding weight gain brought on by depression medication, the theory of aggravation has been reasonably raised by the record. Therefore, an opinion on aggravation is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of any right shoulder disability. The examiner should review the claims file and note that review in the report. All indicated tests should be conducted. The examiner should discuss the Veteran’s lay statements regarding the history and continuity of symptomatology. The examiner should provide an explanation for all conclusions. The examiner should note that a right shoulder pre-existed entrance to service. The examiner should opine whether there is clear and unmistakable evidence that any right shoulder disability was not aggravated (increased in severity beyond the natural progress of the disorder) during active service, to include documented treatment and complaints for right shoulder pain in-service. The examiner should specifically discuss whether any symptoms during service represented an increased in severity beyond the natural progress of the disorder. 2. Schedule the Veteran for a VA examination conducted by a medical doctor to obtain an opinion as to the nature and etiology of any diagnosed sleep disability during the duration of this appeal. The examiner must review the claims file and should note that review in the report. The examiner should consider and discuss the medical records regarding any sleep difficulty. If the examiner determines that any diagnosed sleep disability is not the result of active service, and another etiology can be determined, the examiner should provide an opinion as to what likely caused the sleep disability, taking into account the Veteran’s full post-service work and medical history. The examiner should discuss the Veteran’s lay statements regarding the history and continuity of symptomatology. The examiner should provide a complete rationale for all conclusions. The examiner should provide the following opinions: (a.) Is it at least as likely as not (50 percent or greater probability) that any sleep disability had its onset during active service or otherwise originated during active service? The examiner should address the statement submitted by the Veteran’s spouse, detailing observations of the Veteran snoring and exhibiting sleep apnea symptoms within six months of separation from service. (b.) Is it at least as likely as not (50 percent probability or greater) that any sleep disability has been caused by service-connected disabilities, to include the Veteran’s assertion that his depression led to weight gain because it caused a “lack of interest into doing any kind of physical exercise”? (Continued on the next page)   (c.) Is it at least as likely as not (50 percent probability or greater) that any sleep disability has been aggravated (increased in severity beyond the natural progress of the disorder) by service-connected disabilities? The examiner should address the contention that the medication for service-connected disabilities caused weight gain that led to obesity which contributed to OSA. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Cross, 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.