Citation Nr: 21022347 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 17-66 992 DATE: April 15, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from December 2004 to January 2007. The matter comes before the Board of Veterans Appeals (Board) from a March 2017 rating decision of the VA Regional Office (RO). The Veteran testified at a February 2020 Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript is of record. The issue was previously before the Board in July 2020. Based on the Veteran’s Board testimony that he believed his OSA was not caused or made worse by his service-connected psychiatric disability, the had Board characterized the issue as reflected above and remanded for a VA examination. The July 2020 examiner considered the Veteran’s mother’s statements in her findings. The Board finds that there has been substantial compliance with the remand directives. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). 1. The claim for entitlement to service connection for sleep apnea is remanded. Although the Veteran limited his claim to direct service connection at his hearing, in a March 2021 Written Brief Presentation, his representative raised the theory of secondary service connection. The representative argued that the Veteran’s sleep apnea was secondary to his service-connected bipolar disorder and cited to some studies addressing whether there is a connection between these two conditions. VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79, 86 (2006). The threshold for determining whether the evidence “indicates” that there “may” be a nexus between a current disability and an in-service event, injury, or disease is a low one. Id., at 83. The Veteran’s representative has raised the theory of secondary service connection and provided evidence that indicates there may be an association between his sleep apnea and his service-connected bipolar disorder. The record is not sufficient to decide the claim. An addendum opinion is necessary. The matters are REMANDED for the following action: 1. Provide the Veteran’s claims file to a suitable clinician so a supplemental opinion may be provided for the Veteran’s sleep apnea. The entire claims file and a copy of this remand must be made available to the clinician for review. A physical or telehealth examination of the Veteran is only required if deemed necessary by the clinician. Although an independent review of the claims file is required, the clinician’s attention is called to the studies cited to in the Veteran’s representative’s March 2021 Written Brief Presentation. The clinician must opine as to the following: 2. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s sleep apnea was proximately due to or the result of his service-connected bipolar disorder. 3. Whether it is at least as likely as not that his sleep apnea was aggravated beyond its natural progression by his service-connected bipolar disorder. The clinician must provide a complete rationale for his or her opinion(s) in the examination report. 4. Readjudicate the claim. If any decision is unfavorable to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Stevens, 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.