Citation Nr: 21021565 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 16-01 327 DATE: April 13, 2021 REMANDED Service connection for sleep apnea is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from August 1979 to June 1980. This appeal is before the Board of Veterans’ Appeals (Board) from a May 2015 rating decision appealed in a timely August 2015 notice of disagreement (NOD) and perfected by a timely December 2015 substantive appeal in response to November 2015 statement of the case (SOC). In January 2021, a hearing was held before the undersigned; a transcript is of record. 1. Service connection for sleep apnea is remanded. The Veteran has not been examined in conjunction with this claim despite having (1) a confirmed diagnosis by February 2012 sleep study and (2) competently reported that his sleep difficulties are related to service, noting a long history of observable symptoms of daytime sleepiness that began shortly after discharge. Therefore, an examination is needed. The matters are REMANDED for the following action: 1. Obtain all updated records (i.e., those not already of record) of VA and adequately identified private treatment the Veteran has received for the disabilities remaining on appeal, TO SPECIFICALLY INCLUDE BUT NOT LIMITED TO any prior sleep studies, such as one conducted at a Bridgeport Hospital (presumably in New Haven) sometime between 1999 and 2002. 2. Schedule the Veteran for an in-person or telehealth (whichever is appropriate) examination by an appropriate clinician to determine the likely cause of his sleep apnea. Based on a review of the record, examination of the Veteran (INCLUDING A COMPLETE SUBJECTIVE HISTORY AND REPORT DESCRIBING ONSET, COURSE, AND PROGRESSION OF HIS SYMPTOMS), and any tests or studies deemed necessary, the examiner must respond to the following: (a.) Is it AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such disability is related to the Veteran’s military service, to include considering his reports of observable symptoms of sleep difficulties therein, persisting sleep difficulties (e.g., observable symptoms of daytime drowsiness, falling asleep on the job) thereafter, and formal evaluation and diagnosis as early as between 1999 and 2002 (particularly given he has both testified to this medical history before the undersigned and provided similar reports to VA clinical treatment providers)? (b.) Is it AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that the Veteran’s sleep apnea is CAUSED BY OR PROXIMATELY DUE TO his comorbid service-connected disabilities, to include as a result of pain (particularly given the several records indicating pain associated with his various orthopedic conditions contributes to sleep interference)? (c.) Is it AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such is AGGRAVATED (WORSENED BEYOND ITS NATURAL PROGRESSION, REGARDLESS OF PERMANENCE) BY his comorbid service-connected disabilities, to include as a result of pain (particularly given the several records indicating pain associated with his various orthopedic conditions contributes to sleep interference)? All opinions must include a detailed rationale. Providing an opinion or conclusion without enough explanation will delay processing of the claim and require further clarification. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yuan, 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.