Citation Nr: 21014140 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 16-02 366 DATE: March 11, 2021 REMANDED The issue of service connection for obstructive sleep apnea, to include as secondary to service-connected deviated nasal septum, is remanded. The issue of service connection for hypertension, to include as secondary to the claimed obstructive sleep apnea disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1977 to September 1981. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2013 rating decision. In March 2019, the Veteran testified at a Board hearing; a transcript of the hearing is associated with the claims file. In a July 2019 decision, the Board denied service connection for sleep apnea and hypertension. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (Court). In a May 2020 Memorandum Decision, the Court vacated the Board’s July 2019 decision and remanded the case to the Board. In November 2020, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for further development in accordance with the Memorandum Decision. Finally, the May 2013 rating decision had granted service connection for “sinusitis secondary to deviated septum” and denied service connection for “residuals of deviated septum.” The Veteran’s appeal included the issue of service connection for a deviated nasal septum. The July 2019 Board decision granted service connection for residuals of a deviated nasal septum. A review of the electronic claims file indicates the AOJ has not yet effectuated that decision. The AOJ should issue a rating decision effectuating the Board’s grant of the claim for service connection for residuals of a deviated nasal septum and notify the Veteran of the decision. 1. The issue of service connection for obstructive sleep apnea, to include as secondary to service-connected deviated nasal septum, is remanded. The Veteran contends that his obstructive sleep apnea, which was diagnosed by a private sleep study in April 2010, is secondary to his service-connected residuals of a deviated nasal septum. In November 2020, the Board remanded the appeal, in part, to obtain a medical opinion as to whether the Veteran’s residuals of a deviated nasal septum aggravated his obstructive sleep apnea. In December 2020, a VA physician reviewed the Veteran’s electronic claims file and opined it was less likely as not that the deviated nasal septum either caused or aggravated his obstructive sleep apnea. The reviewing examiner provided a detailed explanation to support the conclusion that the Veteran’s deviated nasal septum did not proximately cause his sleep apnea, describing the factors that more likely contributed to his sleep apnea, such as obesity with a BMI of 38.9, large neck measuring 18.5 inches, and Mallampati class IV oral cavity at the time of diagnosis. Unfortunately, the opinion did not include a rationale to support the conclusion that it was less likely as not that the residuals of a deviated nasal septum aggravated the Veteran’s sleep apnea. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The AOJ should request a supplemental medical opinion. 2. The issue of service connection for hypertension, to include as secondary to the claimed obstructive sleep apnea disability, is remanded. The Veteran contends that his current hypertension was caused or aggravated by his claimed obstructive sleep apnea disability. Alternatively, he asserts that his hypertension began during military service. His service treatment records document a three-day blood pressure check in September 1977 in which his diastolic pressure was recorded as 90 or greater during morning and afternoon checks on each day. During the next four consecutive days, his blood pressure readings during morning and afternoon checks were consistently normal. During a March 2013 VA examination, the Veteran reported that he was found to have elevated blood pressure during a physical examination and started on treatment for hypertension in 2000. The service connection claim for hypertension is dependent, in part, on the outcome of the service connection claim for obstructive sleep apnea. Because these claims are inextricably intertwined, the service connection claim for hypertension also must be remanded. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain any ongoing treatment records from the East Orange VA Medical Center dating since December 2020. 2. Provide the Veteran’s electronic claims file to the December 2020 reviewing VA examiner or to another appropriate clinician to obtain an addendum medical opinion regarding his hypertension. Following a review of the claims file, the reviewing clinician should provide a medical opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s obstructive sleep apnea is or has been aggravated by (Continued on next page) service-connected residuals of a deviated nasal septum. A detailed medical rationale must be provided for all opinions expressed. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Laura Kirscher Strauss 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.