Citation Nr: 21012616 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 11-27 977 DATE: March 4, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1989 to July 2009, to include service in Southwest Asia. His awards and decorations include the Air Force Combat Action Medal among others. This matter on appeal to the Board of Veterans’ Appeals (Board) from a September 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Board remanded this issue. The Veteran asserts that his current OSA is related to active service. The Veteran contends that he has had sleep problems for more than half of his military service. See August 2019 Statement. The Veteran also contends that a sleep study was never attempted or suggested by doctors in service. Id. A medical opinion was obtained in December 2020 as to whether the OSA manifested during service and if it may have been related to the Veteran’s service-connected deviated septum. The examiner found the OSA was less likely than not incurred in or caused by service. In supporting the opinion, the examiner opined that there was no evidence of OSA in service, finding that a post deployment health assessment in February 2005 was negative for both sinus condition and OSA symptoms. The examiner noted that the Veteran’s complaints are general and attributable to any number of causes. The examiner noted that snoring is not evidenced in the record and that a deviated septum would be less likely to be a cause of OSA. Finally, the examiner opined that there are no indications of apneic episodes until the sleep study conducted in December 2012, three years after the Veteran retired from service. The Board finds this opinion is not sufficient. The examiner notes no relevant symptoms during a February 2005 health assessment and that there is no separation examination. However, a separation physical was performed on March 17, 2009. At the time, the examiner noted a history that included hypertension, insomnia, chronic fatigue, deviated septum, and other conditions. Two weeks prior to that examination, the Veteran reported for a physical examination in connection with VA. During that examination, among other things, the Veteran complained of chronic fatigue, deviated nasal septum, insomnia, and hypertension. Chronic trouble sleeping was also noted, as was the fact that he had never had a sleep study and that he was unaware of significant snoring. The record indicates that the Veteran has complained of sleep related issues since April 1998 when he reported being tired and that sleep did not help his fatigue. In a December 2019 VA examination for chronic fatigue syndrome, the examiner opined that his diagnosed sleep apnea and PTSD account for the symptoms reported. The symptoms reported were “fatigue since 1999, stopping breathing, and frequent daytime napping.” These symptoms are consistent with the record and are also symptoms of sleep apnea. See Obstructive Sleep Apnea, Mayo Clinic https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090. In addition, the Board notes that excessive daytime sleepiness and high blood pressure are symptoms of sleep apnea that were also noted in service treatment records from 1998 to 2009. While the December 2020 medical opinion addressed that snoring was not noted in the Veteran’s record, the Board notes that the Veteran often slept by himself as he was single with no children and would most likely not have known whether he snored or not. See also March 2009 examination (noting “he is unaware of significant snoring”). In the April 2012 sleep assessment, the medical examiner noted that the Veteran was likely a snorer who sleeps alone, had a narrow upper airway that put him at risk for sleep apnea, and reported that his father also used a continuous positive airway pressure (CPAP) machine. Based on the foregoing, the Board finds the medical opinion does not sufficiently address the etiology of the Veteran’s OSA and whether it was likely caused by or incurred in service. Therefore, a remand is necessary to obtain another nexus opinion regarding the Veteran’s OSA. The matter is REMANDED for the following action: The claims file should be sent to an appropriate examiner to offer an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the current OSA onset during service or is otherwise related to an in-service injury, event, or disease, to include reports of fatigue, drowsiness, high blood pressure, and chronic trouble sleeping. While snoring is not shown in service records, an April 2012 sleep assessment indicates that the Veteran was likely a snorer who sleeps alone. The examiner should also address whether the OSA is at least as likely as not (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected hypertension. (Continued on the next page.) The need for an examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Jarman, 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.