Citation Nr: 21021226 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 16-23 982 DATE: April 12, 2021 REMANDED Entitlement to service connection for sleep apnea, claimed as a sleep disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1983 to October 1983 and from June 1986 to October 2006. In December 2018 and June 2020, the Board remanded the issue of service connection for a sleep disorder. An August 2020 rating decision granted service connection for insomnia, as part and parcel of the 100 percent evaluation assigned for the Veteran’s service-connected posttraumatic stress disorder (PTSD) with unspecified depressive disorder. An August 2020 supplemental statement of the case, issued simultaneously with the August 2020 rating decision, denied service connection for sleep apnea. Entitlement to service connection for sleep apnea, claimed as a sleep disorder, is remanded. There has not been substantial compliance with the Board’s prior remands. Stegall v. West, 11 Vet. App. 268 (1998). The Board remands this issue for an adequate medical opinion in compliance with the December 2018 and June 2020 remands. A July 2020 VA medical opinion stated that the Veteran’s sleep apnea was less likely than not related to active duty. The July 2020 examiner explained, in part, that the Veteran’s service treatment records were silent for diagnosis of or signs and symptoms suggestive of sleep apnea. However, the July 2020 examiner failed to specifically address the Veteran’s service treatment records showing that he had difficulty sleeping due to trauma exposed to while deployed to Iraq, as requested by both prior Board remand. While a later August 2020 VA medical opinion, by a separate examiner, concluded that the Veteran’s current insomnia was a progression of the symptoms inherent in the Veteran’s service-connected PTSD, the July 2020 examiner failed to explain why the Veteran’s documented in-service sleep difficulty was not a sign or symptom of his separately diagnosed sleep apnea. Ultimately, the July 2020 rationale is nearly verbatim to the rationale provided by a September 2019 VA addendum medical opinion that was deemed inadequate by the Board in June 2020. In addition, the July 2020 examiner explained, in part, that there was no documentation of chronicity of symptomology since separating from service. This statement ignores an August 2014 account from the Veteran’s wife that she had endured seven years of the Veteran’s sleep disorder, meaning that his sleep apnea existed shortly after his separation from active duty and had continued since that time. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (holding that an examination must consider lay evidence of in-service incurrence or continuity of symptomatology since service). Accordingly, on remand, the Agency of Original Jurisdiction should obtain an adequate VA medical opinion that complies with the December 2018 and June 2020 remands. The matter is REMANDED for the following actions: 1. Please obtain an addendum opinion from an appropriate clinician regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea had its onset during active service or is otherwise related to active service. The clinician must review the Veteran’s eFolder. The clinician is requested to specifically comment on the Veteran’s service treatment records, to include dated in March 2006, that documented his reports of “difficulty sleeping” due to “trauma he was exposed to while deployed in Iraq.” The clinician is also requested to specifically comment on an August 2014 statement from the Veteran’s wife that she had endured seven years of the Veteran’s sleep disorder, meaning that his sleep apnea existed shortly after his separation from active duty and had continued since that time. The clinician must provide a complete rationale for any opinion expressed. If the clinician cannot provide an opinion without resort to speculation, he or she should provide an explanation as to why this is so and identify what, if any, additional evidence would permit such an opinion to be made. 2. Thereafter, readjudicate the issue on appeal. If the benefit sought is not granted, furnish the Veteran and his representative with a supplemental statement of the case and afford them an opportunity to respond before the record is returned to the Board for further review. M. ESPINOZA Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Davitian, 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.