Citation Nr: 21021363 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 18-01 170 DATE: April 12, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from October 1969 to August 1971 and from January 1991 to June 1991 with additional periods of service in the Army Reserves. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Jurisdiction of the case is now before the RO in Atlanta, Georgia. In November 2018, the Board remanded the issue on appeal for additional development. As the actions specified in the remand have been substantially completed, the matter has been properly returned to the Board for appellate consideration. See Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). 1. Entitlement to service connection for obstructive sleep apnea. During the period on appeal, the Veteran has in part argued that his service-connected disabilities have resulted in him becoming obese, which in turn has caused his claimed sleep apnea. Further, the most recent VA opinion clearly linked the Veteran’s sleep apnea to his weight gain from 2015 to 2019. As such, the Board finds that the question of whether the Veteran’s service-connected disabilities resulted in his obesity, which in turn caused his sleep apnea, has been raised by the record. Garner v. Tran, No. 18-5865, 2021 U.S. App. Vet. Claims LEXIS 81 (Jan. 26, 2021). As such, the Board must remand for another addendum opinion as to what extent, if any, the Veteran’s service-connected disabilities caused or aggravated his obesity, and whether his obesity in turn was the proximate cause of his sleep apnea. VA Gen. Coun. Prec. 1-2017 (Jan. 6, 2017); see Walsh v. Wilkie, 32 Vet. App. 300 (2020). The matters are REMANDED for the following action: 1. Obtain an addendum VA medical opinion from the examiner who provided the November 2019 opinion, or another appropriate individual is the November 2019 examiner is unavailable. The examiner should address the following: a) Is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s obesity was caused or aggravated by his service-connected disabilities, to include the use of insulin for his diabetes mellitus? b) If so, is it at least as likely as not (a fifty percent probability or greater) that the obesity, or the aggravation of his obesity, was a substantial factor in causing the Veteran’s sleep apnea? c) If so, is it at least as likely as not (a fifty percent probability or greater) that BUT FOR the obesity, or the aggravation of the obesity, the Veteran would not have been diagnosed with sleep apnea? A detailed rationale for the opinion must be provided. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as against it. CHRISTOPHER A. WENDELL Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Journet Shaw, 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.