Citation Nr: 21025056 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 15-06 315 DATE: April 27, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1990 to May 1991. This case originally came before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This case was last before the Board in October 2019, at which time it remanded service connection claims for OSA and an acquired psychiatric disorder. In December 2020, the RO granted service connection for an acquired psychiatric disorder, specifically generalized anxiety disorder. As this issue was resolved by a full grant of benefits and the Veteran has not submitted any documents indicating that she is not satisfied with the decision, the Board finds that this issue is no longer part of the current appeal. See 38 C.F.R. § 19.26(d). However, the service connection claim for OSA remains on appeal. 1. Entitlement to service connection for OSA, to include as secondary to service-connected disabilities, is remanded. The claim for service connection for OSA is again remanded for a VA addendum. Pursuant to the October 2019 Board remand, the Veteran was provided a February 2020 VA examination, at which time the examiner discussed whether the Veteran’s OSA was related to service, as well as his service-connected disabilities, including undiagnosed illnesses manifested by memory loss and fatigue. Subsequently, by way of a December 2020 rating decision, the Veteran was service connected for generalized anxiety disorder. At that time, the service-connected undiagnosed illness manifested by memory loss was combined with the evaluation for generalized anxiety disorder as memory loss was found to be a symptom of generalized anxiety disorder, and separate ratings would constitute pyramiding under 38 C.F.R. § 4.14. Unfortunately, whether the Veteran’s OSA was caused by, aggravated by, or otherwise related to his now service-connected generalized anxiety disorder has not been addressed by any VA examiner. Therefore, a VA addendum is required in order to more completely evaluate the nature and etiology of the Veteran’s OSA, especially now that his memory loss has been combined with a more recently service-connected disability. The matters are REMANDED for the following action: 1. Obtain an addendum opinion by a VA somnologist with regard to the Veteran’s OSA. The need for another examination is left to the discretion of the examiner. However, please note that the Veteran lives outside of the country for six months out of the year. After reviewing the claims file, the examiner is asked to: Provide an opinion as to whether the diagnosed OSA was caused by, aggravated by, or related in any way to the Veteran’s recently service-connected generalized anxiety disorder, which is combined with his service-connected memory loss. **The questions of causation and aggravation must both be addressed. A complete rationale should be provided for all opinions on causation, AND aggravation. 2. Thereafter, readjudicate the remanded claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Lee, 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.