Citation Nr: 21024718 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 18-42 781 DATE: April 26, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for hypertension, to include as secondary to OSA, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1987 to October 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which denied entitlement to service connection for hypertension and OSA. The Veteran filed a notice of disagreement (NOD) in September 2015 and a statement of the case (SOC) was issued in July 2018. He perfected a timely appeal in August 2018. In July 2020, the Veteran presented sworn testimony during a virtual hearing, which was chaired by the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the Veteran’s VA claims file. 1. Entitlement to service connection for OSA is remanded. 2. Entitlement to service connection for hypertension, to include as secondary to OSA, is remanded. The Veteran asserts that he has hypertension and OSA, which were incurred in his active military service. See the Board hearing transcript dated July 2020. He has alternatively contended that his hypertension is secondary to OSA. Id. at pgs. 5-6. In the present case, the Veteran has not been afforded a VA examination for his claimed hypertension or OSA. VA is required to provide an examination or obtain a medical opinion in a claim for service connection when: (1) the record contains competent evidence that the claimant has a current disability or persistent or recurrent symptoms of disability; (2) the record indicates that the disability or symptoms of disability may be associated with active service; and (3) the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A(d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. A claimant’s reports of a continuity of symptomatology can satisfy the requirement for evidence that the claimed disability may be related to service. Id. at 83. The evidence of record documents current diagnoses of hypertension and OSA. See the December 2007 and January 2008. With respect to in-service incurrence, the Veteran reported that he had high blood pressure readings during his active duty service and experienced dizziness with episodes of elevated blood pressure. See the July 2020 Board hearing transcript, pg. 8. He additionally testified that he experienced snoring during his military service, as well as awakenings with gasping for air. Id. at pg. 11. Service treatment records (STRs) dated in January 1988 document the Veteran’s complaints of dizziness; however, the onset of the dizziness was identified as a January 1988 motor vehicle accident. Elevated blood pressure readings were not shown at that time. However, STRs dated in November 1989 noted blood pressure of 150/94. An undated STR indicated blood pressure of 145/77 and blood pressure of 140/66 was documented in September 1995. As to the Veteran’s report of in-service snoring and nocturnal gasping for air, he is competent to testify as to such lay observable symptoms. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F .3d 1331 (Fed. Cir. 2006). Therefore, the evidence indicates that the Veteran has current hypertension and OSA disabilities that may be associated with service and a remand is warranted to afford the Veteran an appropriate VA medical opinion to determine the etiology of his claimed disabilities. 38 U.S.C. § 5103A(d); McLendon, supra. The matters are REMANDED for the following action: The AOJ shall refer the VA claims file to a clinician with appropriate expertise to provide an opinion as to the claimed hypertension and OSA disabilities. The clinician is requested to review the claims file in its entirety including all service treatment records, VA, and private treatment records. If the clinician determines that an examination is necessary, one should be scheduled. The clinician should then respond to the following: (a). Whether it is at least as likely as not that a diagnosed OSA and/or hypertension began during active service or is related to an in-service injury, event, or disease? (b). If not, is it at least as likely as not that a diagnosed hypertension was caused by OSA? (c) If not, is it at least as likely as not that the Veteran’s diagnosed hypertension is aggravated (made worse as shown by comparing the current disability to medical evidence created prior to any aggravation) by OSA? If the Veteran’s claimed hypertension is aggravated by OSA, the examiner should also indicate the extent of such aggravation by identifying the baseline level of disability. This may be ascertained by the medical evidence of record and also by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. In addressing the above, the examiner must consider the Veteran’s description of his in-service symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disabilities, this should be noted. Stated another way, do the Veteran’s reports about his symptoms such as dizziness and snoring align with how OSA and hypertension are known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? (Continued on the next page)   In this regard, the examiner should note that the absence of evidence of treatment for claimed disabilities in the Veteran’s service treatment records should not serve as the sole basis for a negative opinion. All examination findings/testing results (if any), along with complete, clearly-stated rationale for the conclusions reached, must be provided. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. K. Buckley, 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.