Citation Nr: 21024964 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 17-41 876 DATE: April 27, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1953 to October 1957. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in October 2018 and September 2020 and was remanded for additional development. The case is once again before the Board. Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. The Veteran asserts that his service-connected psychiatric disorder caused or aggravated his OSA. He is service connected for an anxiety disorder with sleep impairment, tinnitus, bilateral hearing loss, and gastroesophageal reflux disease (GERD), which is secondary to his anxiety disorder. In the Veteran’s April 2021 appellate brief, he asserts that his service-connected psychiatric disability caused or aggravated his obesity, he also notes that he has been obese since service. See April 2021 Appellate Brief. The Veteran has a diagnosis of OSA, and the Board has remanded this claim for an opinion on whether the Veteran’s service-connected anxiety disorder caused or aggravated his OSA. An opinion was provided in October 2020 that indicates the Veteran’s OSA is caused by obesity and is not caused or aggravated by his anxiety disorder. See October 2020 Opinion. The examiner noted medical literature showing obesity is the leading risk for OSA. The examiner noted that polysomnography testing showed OSA, rather than central apnea which would be due to central nervous system issues. The examiner also noted that medical literature weighed against a finding of aggravation by his service-connected psychiatric disability. A veteran is entitled to disability compensation when a service-connected disability causes or aggravates a non-service-connected disability. In a precedent opinion, the United States Court for Veterans Claims (CAVC) addressed VAOPGCPREC 1-2017 and indicated that service connection may also be granted on a secondary basis where the claimed disability would not have occurred but for obesity aggravated by a service-connected disability. Walsh v. Wilkie, 32 Vet. App. 300, 302 (2020). The Board finds the Veteran’s arguments specifically raise the theory of entitlement via obesity as an intermediate step and the October 2020 VA examination indicates the Veteran’s OSA is directly associated with his obesity, along with other causes of alcohol abuse, and chronic obstructive pulmonary disorder. Given the Veteran’s arguments and the opinion from the October 2020 VA examiner, the Board finds an additional medical opinion is needed. The matters are REMANDED for the following action: Arrange for the Veteran’s complete claims file to be forwarded to an appropriate medical professional for review. After reviewing the claims file the examiner must provide a medical opinion that addresses whether Veteran’s OSA is secondary to (was caused or aggravated by) his service-connected anxiety disorder and associated GERD. The examiner must specifically consider the Veteran’s April 2021 contentions that service-connected anxiety disorder and associated GERD, caused obesity, and the obesity, in turn, was a substantial factor in his development of OSA. The examiner should specifically address the Veteran’s contentions regarding obesity in service and the evidence submitted with the April 2021 appellate brief in formulating their response. If further examination of the Veteran is deemed necessary for the opinion sought, such should be arranged. The consulting provider must respond to the following with explanation for each question: a. Is it at least as likely as not (a 50% or greater probability) that the Veteran’s service-connected anxiety disorder and associated GERD, and/or the medication prescribed for those disabilities, caused him to become obese (i.e., by negatively impacting ability to exercise, stimulating appetite, affecting metabolism)? b. If so, was the obesity caused by his service-connected disabilities and/or medication prescribed for those disabilities, at least as likely as not a substantial factor in causing his OSA? c. Would the OSA not have occurred but for the obesity caused by the service-connected disabilities and/or medication prescribed for those disabilities? Include rationale with all opinions. The examiner is reminded that a medical opinion based solely on the absence of documentation in the record or that does not address the Veteran’s reports of symptoms and history is inadequate. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A rationale for all opinions expressed should be provided as the Board is precluded from making medical findings. A discussion of the facts and the medical principles involved will be of considerable assistance to the Board, including citation to any supporting medical treatises. A.M. CLARK Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Trickey 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.