Citation Nr: 21015708 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 07-36 806 DATE: March 18, 2021 REMANDED Entitlement to service connection for a sleep disorder other than insomnia, to include as secondary to service-connected posttraumatic stress disorder (PTSD), and/or as a chronic qualifying disability, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the U.S. Marine Corps from August 1991 until October 1995, and in the U.S. Army from May 2005 until September 2006. The Veteran had additional service in the Reserves. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a May 2007 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2013, the Veteran presented testimony before the undersigned Veterans Law Judge. In January 2020 the Board denied entitlement to service connection for a sleep disorder other than insomnia. The Veteran appealed that denial to the United States Court of Appeals for Veterans Claims (Court). In a September 2020 Order, the Court granted the parties’ Joint Motion for Remand (JMR) and remanded the matter to the Board with instructions to obtain an adequate medical opinion addressing whether a sleep disorder was caused or aggravated by a service-connected disability. The case has been returned to the Board for action consistent with the parties’ JMR. 1. Entitlement to service connection for a sleep disorder other than insomnia, claimed as sleep apnea, to include as secondary to PTSD or as a chronic qualifying disability is remanded. This issue is remanded to obtain any outstanding medical records and to secure an addendum opinion on whether service-connected PTSD caused or aggravated sleep apnea. The Veteran was afforded a VA examination in May 2019. The May 2019 VA examiner opined that diagnosed sleep apnea was not caused or aggravated by PTSD. The examiner cited to medical literature, and explained that PTSD and sleep apnea were comorbid, meaning that they often existed together, but that did not equate to a causal relationship between the two conditions. The examiner further explained that there was some evidence that treating sleep apnea could improve PTSD symptoms, but the medical literature does not show that treating PTSD improved sleep apnea. Thus, the examiner concluded that PTSD did not cause or aggravate the Veteran’s sleep apnea. In the JMR, the parties agreed that the examiner did not provide a rationale that dealt with causation and aggravation as independent concepts with separate rationales. Thus, remand for an addendum is required. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the diagnosed sleep apnea from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, it shall be provided. An explanation for all opinions expressed must be provided. (a.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that sleep apnea is caused by the service-connected PTSD. (b.) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that sleep apnea is aggravated by the service-connected PTSD. (c.) The examiner is requested to provide clear and separate rationales that address causation and aggravation as independent concepts. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Smith, 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.