Citation Nr: 21014527 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 15-21 870 DATE: March 12, 2021 REMANDED Entitlement to service connection for a sleep disorder, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. Entitlement to an effective date prior to June 14, 2012 for eligibility to Dependents’ Educational Assistance (DEA) under 38 U.S.C. Chapter 35, is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 2002 to November 2002 and October 2003 to February 2005. These issues were remanded by the Board in a November 2019 decision for further development. The issues have since returned to the Board for appellate review. 1. Entitlement to service connection for a sleep disorder, to include as secondary to PTSD, is remanded. Remand is necessary to obtain an addendum VA opinion, or a new VA examination if necessary. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate “where it is based on consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one.” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The VA treatment records are silent for a diagnosis of sleep apnea or any sleep disorder. In 2014, the Veteran was referred for a sleep study to assess the Veteran’s sleep disturbance. In an April 2016 VA sleep examination, the examiner indicated the Veteran does not have or has ever had sleep apnea. The examiner stated the Veteran has comorbid PTSD rating with symptoms of sleep disturbance and he has not had a sleep apnea diagnosis but gives credible reports of insomnia symptoms. The examiner indicated the Veteran does not have any findings, signs, or symptoms attributable to sleep apnea. The examiner noted the Veteran was provided a sleep study in April 2016. The examiner did not have the opportunity to review the sleep study but remarked that that the Veteran needed a mental health examination. On the July 2020 VA examination, the examiner stated the Veteran reported sleep disturbance as a symptom of PTSD and there is no separate diagnosis for insomnia. The examiner stated that the Veteran sleep disturbance is a symptom of PTSD. However, the examiner stated that a sleep study is suggested as the Veteran reports that he stops breathing in his sleep. Therefore, remand is required to obtain a VA examination for sleep apnea, to include a sleep study. 2. Entitlement to an effective date prior to June 14, 2012 for eligibility to DEA is remanded. 3. Entitlement to a TDIU is remanded. Finally, because a decision on the issue of entitlement to service connection for sleep apnea could significantly impact a decision on the issues of an earlier effective date for the award of DEA and entitlement to TDIU, the issues are inextricably intertwined. A remand of the claims for an earlier effective date for the award of DEA and entitlement to a TDIU is required. The matters are REMANDED for the following action: 1. Provide the Veteran a VA examination from an appropriate clinician to determine the nature and etiology of the Veteran’s sleep disorder, to include consideration of reports that the Veteran stops breathing during his sleep. The Veteran must be provided a sleep study. The examiner must opine: (a.) Whether the Veteran has a sleep disorder, separate from the Veteran’s sleep disturbance attributable as a symptom of PTSD. (b.) If so, whether it is at least as likely as not that any diagnosed sleep disorder is caused by service. (c.) And, whether it is at least as likely as not that: • The Veteran’s sleep disorder was caused by service-connected PTSD, or • The Veteran’s sleep disorder was aggravated beyond its natural progression by service-connected PTSD. The examiner must provide a well-reasoned response to the above inquiry and must specifically discuss the Veteran’s report of breathing stoppage during sleep and the effects of sleep disturbance on any diagnosed sleep disorder. 2. The AOJ must review the claims file and ensure that the foregoing development action has been completed in full. If any development is incomplete, appropriate, corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. T. Berry Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Thompson. 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.