Citation Nr: 21024277 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 15-44 302 DATE: April 22, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served in the United States Navy on active duty from October 1992 to April 1999. The issue comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The issue was previously before the Board in August 2018. The Board remanded to obtain outstanding medical records and to provide a medical opinion regarding the Veteran’s obstructive sleep apnea. Although the Board regrets further delay, another remand is necessary to provide the Veteran with every possible consideration. Further development is necessary prior to appellate review to provide the Veteran with an adequate VA medical opinion addressing the etiology of the Veteran’s sleep apnea. Entitlement to service connection for OSA is remanded. The Veteran contends that he suffers from OSA related to his active duty service. Moreover, the Veteran contends that his OSA is not solely caused by obesity. Pursuant to the Board remand, the RO provided the Veteran a VA examination to address his OSA in May 2019. The VA examiner confirmed the Veteran’s diagnosis of OSA. However, the VA examiner provided the medical opinion that the Veteran’s OSA was less likely than not incurred in or caused by the Veteran’s service. The examiner opined that OSA is caused by obesity. Further, the examiner noted the Veteran weighed 281 pounds when diagnosed with OSA in 2011. Thus, the examiner concluded the Veteran’s obesity caused his sleep apnea condition. The VA examiner noted the Veteran and his wife were competent to report his symptoms of snoring and daytime sleepiness. However, the examiner noted these symptoms alone cannot be relied upon to diagnose OSA with any reasonable degree of certainty. Absent sufficient rationale, the May 2019 VA opinion is inadequate. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Here, the May 2019 examiner provided only that OSA is caused by obesity. No other considerations were given to other risk factors. Additionally, the May 2019 medical opinion does not address the Veteran’s private sleep study from March 2002, which provided the Veteran with a diagnosis of borderline sleep apnea. Finally, remand is required to provide a medical opinion addressing the Veteran’s borderline diagnosis of sleep apnea and the Veteran’s private neurologist’s statement from July 2014 regarding the Veteran’s diagnosis of mild positional OSA in 2002. A medical opinion is needed to address the private physician’s note that many patients are suspected to have had sleep apnea for much longer than the official diagnosis. Thus, remand is required to provide an adequate medical opinion fully addressing the etiology of the Veteran’s OSA condition. The matters are REMANDED for the following action: Obtain an opinion as to the etiology of the Veteran’s sleep apnea from an appropriately qualified VA medical professional. If the examiner deems it necessary, afford the Veteran a VA examination. The examination may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. Provide the claims file, including a copy of this REMAND, to the examiner for review. Following a review of the evidence of record, including the Veteran’s March 2002 private sleep study and the Veteran’s July 2014 private medical opinion, the examiner must opine as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s OSA disability had its onset during or is otherwise etiologically related to active duty service. The examiner must provide a comprehensive report including a clearly stated rationale for any opinions offered and conclusions reached, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability. If such reports are rejected by the examiner, a reason for doing so must be provided. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.V. Bona, Associate 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.