Citation Nr: 21021155 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 18-12 991 DATE: April 9, 2021 REMANDED Entitlement to service connection for the Veteran's sleep disorders to include as secondary to the Veteran's service-connected psychiatric disability and lung condition is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1963 to October 1967. This matter comes before the Board of Veteran’s Appeal (Board) on appeal from an August 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded in May 2019 and January 2021 for further development to include a new medical opinion. The case has now returned to the Board for appellate review and, although it again regrets the further delay, the Board finds that additional remand is required. Entitlement to service connection for the Veteran's sleep disorders to include as secondary to the Veteran's service-connected psychiatric disability and lung condition is remanded. The VA must provide an examination or obtain a medical opinion in a claim of service connection when the record contains competent lay or medical evidence of (1) a current diagnosed disability or persistent or recurrent symptoms of disability; (2) evidence establishing that the veteran suffered an event, injury or disease in-service; (3) an indication that the claimed disability or symptoms may be associated with the established event, injury, or disease in-service or with another service-connected disability; and (4) insufficient competent medical evidence for VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The threshold for finding that the disability may be associated with service is low. Id. A Veteran is competent to report his observable symptoms and history, including the onset and timing of symptoms, and such reports must be considered. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  Here, the Veteran filed a claim for service connection for his OSA disability and sleep disorders. See December 2015 Statement in Support of Claim. The Veteran’s September 2013 Private Treatment Records contain a notation stating that the Veteran was diagnosed with narcolepsy in July 2006. See September 2013 Private Treatment Record. As the Veteran broadly filed for service connection for his OSA disability and sleep disorders, the Board finds that his claim encompasses his narcolepsy disability as well. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Although the Veteran has been afforded a VA examination with respect to his OSA, no opinion has yet been rendered as to whether his narcolepsy condition may be related to service. Accordingly, the Board finds that the issue of service connection for the Veteran’s narcolepsy disability must be remanded to obtain a VA examination addressing narcolepsy. See McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Further, the Veteran filed a claim for service connection for his OSA disability as secondary to his psychiatric disability and sinus condition. See December 2015 Statement in Support of Claim. In January 2016, the Veteran expanded his claim for service for his sinus condition to include a lung condition. See January 2016 VA Form 21-526b Veteran Supplemental Claim Application. In September 2020, the Veteran was service connected for his lung condition, but the Board denied service connection for his sinus condition. See January 2021 Board Decision. Because the Veteran expanded his claim for service connection for his sinus condition to include a lung condition, the Board finds that an addendum opinion is needed to determine whether the Veteran’s OSA was caused by or aggravated by his service-connected lung condition. As the opinion obtained on remand is inadequate, the Board finds that a VA addendum opinion is warranted. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).  The VA addendum opinion must adequately address the Veteran’s in-service complaints of choking and strangulation while sleeping and determine whether these were symptoms of his later diagnosed OSA. The examiner should also determine whether the Veteran’s report of trouble sleeping was an early symptom or sign of the Veteran’s OSA disability and/or narcolepsy disability. Lastly, the examiner should determine whether the Veteran’s OSA and/or narcolepsy condition was caused by or aggravated by the Veteran’s lung condition. In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran’s lay reports.  Rather, the Board is merely requesting that the examiner on remand consider the Veteran’s own descriptions of the history of his OSA and narcolepsy disabilities.  See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of the Veteran’s narcolepsy disability. The entire claims file must be made available to and be reviewed by the examiner. The examiner must address the following: (a.) Please state whether it is at least as likely as not (50 percent probability or more) that the Veteran’s narcolepsy disability had its onset in, was caused by, or is otherwise related to service.  (b.) For the purpose of providing the opinion requested, please accept as valid the Veteran’s statements that he has experienced trouble sleeping, and state whether a nexus between the Veteran’s narcolepsy disability and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements).  2. Return the file to the May 2016 VA examiner for an addendum opinion regarding whether the Veteran’s in-service complaints of choking and strangulation while sleeping were or were not early symptoms of his OSA disability. If that examiner is unavailable, the opinion should be provided by another examiner. If a clinical evaluation is deemed necessary to answer the questions presented, one should be scheduled. The claims file, and a copy of the remand, must be reviewed by the examiner. A notation indicating that the claims file and remand was reviewed should be included in the examination report. Following review of the file and this remand, the examiner is to address the following: (a.) Please state whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s OSA disability and/or narcolepsy disability was caused by the service-connected lung condition. (b.) Please state whether it is at least as likely as not that the Veteran’s OSA disability and/or narcolepsy was aggravated by his service-connected lung condition. Here, aggravated means worsened beyond the natural progression of the condition. (c.) Please state whether the Veteran’s in-service complaints of choking and strangulation while sleeping coupled with trouble sleeping were or were not early symptoms of the Veteran’s OSA disability. For the purpose of providing the opinion requested, state whether a nexus between the Veteran’s OSA and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time making an assessment of the credibility of his statements). In offering any opinion, the examiner should consider medical and lay evidence dated both since the filing of the claim (December 2015) including but not limited to the December 1966, September 1967 STR, and September 2013 Private Treatment Record. The examiner should provide a complete rationale for any opinion rendered. If the examiner’s opinion is negative, he or she must clearly explain why. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. S.C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.Foster, 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.