Citation Nr: 21014794 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 16-36 693 DATE: March 15, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to migraine headaches, posttraumatic stress disorder (PTSD) and/or allergic rhinitis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from June 2003 to June 2009. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2015 rating decision issued by a Department of Veterans Affairs Regional Office (RO). The Veteran has filed a claim for service connection for her sleep disorder, alleging direct service connection and secondary service connection as theories of entitlement. The RO denied the Veteran’s claim in September 2015. Subsequently, the Veteran appealed to the Board, where it was denied again in a September 2019 decision. The Veteran then appealed her claim to the United States Court of Appeals of Veterans Claims (Court) where the matter was remanded upon a joint motion to remand, mutually agreed to by both the Veteran and VA. The matter has now returned before the Board for adjudication. 1. Entitlement to service connection for obstructive sleep apnea is remanded. The Veteran contends that her obstructive sleep apnea is either directly or secondarily related to service. The Board finds that a remand is necessary in order to obtain an etiology opinion. As found in the September 2020 JMR, the July 2016 VA examination provided an inadequate rationale as to secondary service connection. The September 2020 JMR also found that the January 2018 VA examination provide an inadequate rationale as to direct service connection. As a result, a remand is required to obtain a new etiology opinion. McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006); See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i). Thus, the Board finds it necessary to remand this matter to correct for the aforementioned inadequacies. The matters are REMANDED for the following action: 1. Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed obstructive sleep apnea. The examiner should review the entire claims file and note such review in the opinion. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following questions: (A) Is it at least as likely as not (50 probability or greater) that the Veteran’s current obstructive sleep apnea had its onset during service or is otherwise related to service? (B) Is it at least as likely as not (50 probability or greater) that the Veteran’s current obstructive sleep apnea was aggravated beyond its natural progression by her service-connected migraine headaches? (C) Is it at least as likely as not (50 probability or greater) that the Veteran’s current obstructive sleep apnea was caused or aggravated beyond its natural progression by her service-connected PTSD? (D) Is it at least as likely as not (50 probability or greater) that the Veteran’s current obstructive sleep apnea was aggravated at all beyond its natural progression by her service-connected allergic rhinitis? A rationale should be provided for all opinions offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kashif I. Ali, 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.