Citation Nr: 21014881
Decision Date: 03/16/21	Archive Date: 03/16/21

DOCKET NO. 15-11 137
DATE: March 16, 2021

REMANDED

Entitlement to service connection for sleep apnea is remanded.

REASONS FOR REMAND

The Veteran served on active duty from February 1991 to December 1992 and from February 2004 to February 2005. He also had periods of active duty for training (ACDUTRA) and inactive duty for training (INACDUTRA), as a member of the Mississippi Army National Guard.

This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).  This case was previously before the Board in September 2019, at which time it was remanded for another VA examination.

Entitlement to service connection for sleep apnea is remanded.

Additional medical opinion is required before the Veteran’s claim for sleep apnea can be properly adjudicated on its merits.

In recent correspondence dated in March 2021, the Veteran’s representative raised a new theory of entitlement to service connection on a secondary basis.  Specifically, it was noted that the December 2019 VA examiner listed depression as one of the causes for insomnia that the Veteran was experiencing in 2006.  While the VA examiner indicated that the diagnosis for insomnia was separate and unrelated to the sleep apnea diagnosis, his representative contended that this represented a link between comorbid symptoms from insomnia and his history of snoring that were ultimately classified as sleep apnea.  It was also asserted that there is a mounting association between depression and sleep apnea.  See March 2021 Appellate Brief.

The Veteran is currently service connected for major depressive disorder and a May 2019 VA examination shows that chronic sleep impairment is a symptom of his disorder. Thus, the Board cannot make a fully-informed decision on the current evidence of record.  Remand is required to obtain a VA medical opinion addressing whether the Veteran’s sleep apnea was caused or aggravated by his service-connected major depressive disorder.  

The matters are REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s sleep apnea.  An in-person examination is not required unless deemed necessary by the clinician.  The clinician is to review the virtual file, including a copy of this Remand.

The clinician is asked to provide a response to the following:

a)	Whether the Veteran’s sleep apnea was at least as likely as not caused by his service-connected major depressive disorder.

b)	Whether the Veteran’s sleep apnea was at least as likely as not aggravated by service-connected major depressive disorder.

A comprehensive rationale for all opinions rendered must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and 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), the record (additional facts are required), or the examiner (does not have the knowledge or training).  

 

MARTHA R. LUBOCH

Acting Veterans Law Judge

Board of Veterans’ Appeals

Attorney for the Board	K. Cruz, 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.