Citation Nr: 21022601 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 19-14 158 DATE: April 16, 2021 REMANDED Service connection for obstructive sleep apnea, including as due to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1960 to August 1980. This matter was most recently before the Board in December 2020; however, there has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Service connection for obstructive sleep apnea, including as due to a service-connected disability is remanded. The claim must be remanded again because the January 2021 and February 2021 VA examinations are inadequate. The VA medical opinions provided in those opinions use the wrong standard for aggravation as aggravated beyond the natural progression of his condition instead of the correct standard of any increase in disability due to any of his service-connected disabilities. Additionally, the prior VA medical opinions cite to studies that appear support the Veteran’s claim, but the examiner’s do not discuss the relevance to the studies cited in the medical opinion. Since the prior VA examinations are inadequate, a new VA examination is warranted. Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with an appropriate VA examiner, to determine service connection for his sleep apnea condition. The claims file and copies of all pertinent records must be made available to the examiner. After reviewing the claims file, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed knee condition was incurred in or is otherwise related to service? (b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed knee condition has been aggravated by any of the Veteran’s service or service-connected disabilities? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation The examiner is asked to review and discuss the following as to any relevance to the Veteran’s claim (i) the study cited in the Veteran’s March 2021 brief published in the Primary Care Companion for CNS Disorders, titled Obstructive Sleep Apnea in Posttraumatic Stress Disorder Comorbid With Mood Disorder: Significantly Higher Incidence Than in Either Diagnosis Alone. https://www.ncbi.nlm.nih.gov/ pubmed/30107101 (last visited April 14, 2021); and, (ii) the studies cited in the January 2021 VA examination. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. 2. Confirm that the VA medical opinions provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. G. Perkins, 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.