Citation Nr: 21016191 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 14-29 622 DATE: March 22, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from September 1966 to September 1969. This matter was previously before the Board of Veterans’ Appeals (Board) in May 2018. At that time, it was remanded for further development. As will be discussed in greater detail below, the matter must once again be remanded for further development. At the time of its May 2018 decision, the Board remanded the matter for a VA examination to determine the etiology of any current sleep apnea. In conjunction with the Board remand, the Veteran was afforded the requested examination in October 2019. Following examination of the Veteran and review of the file, the examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner indicated that the separation examination was not in the file. It was further noted that a diagnosis of sleep apnea was confirmed by a May 2006 sleep study. The examiner indicated that she was unable to confirm objective evidence that the claimed sleep apnea was etiologically related to the Veteran’s period of service. There was no evidence of chronicity of care and a nexus had not been established. As it relates to the examiner’s opinion, the Board notes that the Veteran has claimed that he injured his nose during combat in Vietnam. The Veteran's statements with regard to in-service combat-related events should be considered credible even in the absence of contemporaneous records. See 38 U.S.C. § 1154(b) (2012). In support of his claim, the Veteran’s wife, a retired nurse, indicated that she was married to the Veteran prior to his service in the Vietnam War. She noted that after his return, the Veteran had trouble breathing out of the left side of his nose (leading to excessive snoring and complete lapses in breathing altogether) from a facial injury suffered in one of his firefights during the TET Offensive (1968), a condition that worsened over the years and was finally somewhat improved by a C-PAP device still in use today (Obstructive Sleep Apnea). The Veteran has indicated that upon his separation from service, he found his breathing issues to be manageable and did not realize the condition would worsen with age. He stated that his wife (a retired nurse) brought more serious attention to his sleeping habits (loud snoring, fits of interrupted breathing, and inadvertent leg movements) during the late1980’s & 1990’s. He indicated that after several consults with local ENT specialists (attempting to trace those records), he underwent his first overnight sleep evaluation in May of 2006, which confirmed severe obstructive sleep apnea. In accordance with Dalton v. Nicholson, 21 Vet. App. 23 (2007), the examiner must acknowledge and discuss the Veteran's assertions that he has experienced sleep apnea since service. The Board further observes that the Veteran’s service separation examination and report of medical history are of record. Given the above, additional development is warranted, to include obtaining an addendum opinion addressing the above points and what impact, if any, they have on the prior opinion. The matter is REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claim. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. If available return the claims folder to the October 2019 examiner and request that she provide the following opinion: Is it at least as likely as not (50 percent probability or greater) that any current sleep apnea is etiologically related to the Veteran's period of service? When rendering the above opinion, the Veteran's statements with regard to in-service combat-related events should be considered credible even in the absence of contemporaneous records. The examiner must also consider and address statements from the Veteran regarding the onset and continuity of symptomatology since service. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The examiner must further address and discuss the statements from the Veteran’s wife, a retired registered nurse, as to the onset of continuity of the Veteran’s breathing/snoring problems. For purposes of review the Veteran’s September 1969 service separation examination and report of medical history are of record. (Continued on the next page)   If the examiner is not available, provide the claims folder to an appropriate medical provider with the examiner being requested to provide the above requested opinion. Complete detailed rationale must be provided for each rendered opinion. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. S. Kelly, 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.