Citation Nr: 21022611 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 17-62 259 DATE: April 16, 2021 REMANDED Service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran had active duty from June 1957 to February 1961. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a June 2017 decision. In April 2018, the Veteran had a hearing before the undersigned VLJ; a transcript of the hearing is of record. This issue was previously before the Board in June 2018 when it was remanded for further development. Service connection for sleep apnea, to include as secondary to service-connected PTSD, is remanded. Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310 (a). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310 (b). See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Following the Board’s June 2018 remand, service connection for PTSD was granted in a January 2020 rating decision. Thereafter, in correspondence received in August 2020 the Veteran’s attorney asserted that the Veteran’s sleep apnea was caused or aggravated by his now service-connected PTSD. In support of this assertion, he submitted an article from the National Institute of Health (NIH) titled “The Correlation of Anxiety and Depression with Obstructive Sleep Apnea Syndrome.” Accordingly, a medical opinion should be obtained on remand, as set forth below. The matters are REMANDED for the following action: 1. Obtain the Veteran’s updated VA treatment records. 2. Obtain an addendum medical opinion for the Veteran’s service connection claim for sleep apnea. The claims file and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the opinion. Following a review of the entire record, the examiner should address the following questions: (a.) Whether it is at least as likely as not (50 percent or greater probability) the Veteran’s sleep apnea was caused by his PTSD? (b.) Whether it is at least as likely as not (50 percent or greater probability) any current sleep disorder, to include sleep apnea, was aggravated (i.e., worsened) by his PTSD? The examiner is advised that aggravation may include temporary worsening of a disability. In providing these opinions, the examiner should consider the Veteran’s medical records encourage him to use his CPAP device during every sleep episode and for longer sleep periods in order to maximize the benefit of the CPAP therapy and to control the symptoms of his sleep apnea; that his PTSD symptoms include chronic sleep impairment, insomnia, or a difficulty falling or staying asleep and anxiety (see June 2019 Initial PTSD DBQ); and that he has reported trouble falling or staying asleep. See April 2018 Board Hearing Transcript. The examiner should consider whether the Veteran’s sleep-related symptoms associated with his service-connected PTSD worsen his OSA symptoms or affect the efficacy of his CPAP machine in controlling his OSA symptoms. The examiner should also consider the NIH article submitted by the Veteran’s attorney in August 2020 titled “The Correlation of Anxiety and Depression with Obstructive Sleep Apnea Syndrome.” The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. P. M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Denton, Buck 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.