Citation Nr: 21014474 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 11-25 330 DATE: March 12, 2021 REMANDED Entitlement to service connection for a sleep disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1983 to October 1983 and from June 1986 to July 2007. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in March 2010 by a Department of Veterans Affairs (VA) Regional Office. In a November 2016 decision, the Board denied service connection for a sleep disorder, which the Veteran subsequently appealed to the United States Court of Appeals for Veterans Claims (Court). In October 2017, pursuant to a Joint Motion for Partial Remand, the Court vacated and remanded the Board’s decision. In December 2017, December 2019, and September 2020, the Board remanded the case for additional development and it now returns for further appellate review. Entitlement to service connection for a sleep disorder. The Board finds that a remand is necessary in order to afford the Veteran a VA examination that complies with its prior remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, in December 2017, the Board directed that he be afforded a VA examination so as to determine the nature and etiology of his claimed sleep disorder that was conducted by a physician with experience in the diagnosis and treatment of sleep disorders. The Board further directed that the examiner specify his or her qualifications for diagnosing or assessing sleep disorders. In December 2019 and September 2020, the Board remanded the claim as the October 2018 and January 2020 VA examinations, respectively, were conducted by nurse practitioners. Pursuant to the September 2020 remand, the Veteran was afforded a VA mental disorder examination conducted by a psychologist in November 2020. At such time, she determined that he did not have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), diagnosis of a sleep disorder, to include sleep apnea or insomnia disorder, as an October 2018 sleep study was unremarkable for obstructive sleep apnea and he denied using any medications for sleep disturbance. However, while she has expertise in diagnosing psychiatric disorders such as insomnia disorder, she is not a physician and did not specify her qualifications for diagnosing or assessing sleep disorders, such as sleep apnea, as directed by the Board. Thus, another remand is necessary in order to afford the Veteran an appropriate VA examination addressing such matter. The matter is REMANDED for the following action: Afford the Veteran an appropriate VA examination conducted by a physician with experience in the diagnosis and treatment of sleep disorders to determine the nature and etiology of his claimed sleep disorder. The record, to include a complete copy of this Remand, must be made available to the examiner. All indicated tests and studies should be accomplished, and all clinical findings should be reported in detail. The examiner must specify his or her qualifications for diagnosing or assessing sleep disorders. Thereafter, the examiner should address the below inquiries: (A) Identify all current sleep disorders, to include sleep apnea, that have been present at any point proximate to the Veteran’s October 2009 claim, even if such is asymptomatic or has since resolved. If no sleep disorder is diagnosed, the examiner should offer an opinion as to whether the Veteran’s symptomatology results in functional impairment of earning capacity. If so, the examiner is advised that he or she should accept that the Veteran has a disability for the purpose of rendering the opinions requested below. (B) For each sleep disability, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, his service. (C) For each sleep disability, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such is caused or aggravated by a service-connected disability. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. A rationale should be provided for any opinion offered. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Koria B. Stanton, 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.