Citation Nr: 21013826 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 14-44 443 DATE: March 10, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, including as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1997 to May 2001, to include service in Southwest Asia. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing with the undersigned in July 2017. The Board subsequently denied this claim and the Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). The Court remanded the issue back to the Board pursuant to a Joint Motion for Partial Remand (JMR) filed by the parties in May 2019. The Board then remanded the issue for additional development in October 2019 and September 2020 and it has now returned for further adjudication. Although the Board regrets additional delay, remand is necessary to properly address the Veteran’s claim. In September 2020, the Board remanded this issue for an addendum opinion to determine in part if the Veteran’s PTSD aggravated his sleep apnea as the record was unclear on this point. The Board requested that a sleep study be performed unless the examiner explained why such was not indicated or the Veteran did not consent. A new sleep study was not done. In addition, the examiner in October 2020 opined that PTSD did not aggravate the Veteran’s sleep apnea as PTSD does not physically cause sleep apnea. This is the same reasoning from the February 2017 opinion which was rejected in the JMR. As such, remand is necessary to obtain a new sleep study and then to determine if the Veteran’s PTSD has caused or aggravated his sleep apnea. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to determine whether it is at least as likely as not (50 percent probability or greater) that the current sleep apnea was (a) caused by, or (b) aggravated by (worsened beyond natural progression) service-connected PTSD. A sleep study should be performed unless the Veteran does not consent. (Continued on the next page.) A rationale for all opinions expressed is requested as adjudicators are precluded from making any medical findings. Stating PTSD does not cause sleep apnea will not be a sufficient rationale for an opinion about aggravation. Instead, the examiner is asked to explain why this Veteran’s sleep apnea was or was not aggravated by his PTSD. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Hofmeister, Attorney Advisor 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.