Citation Nr: 21025088 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 16-09 195 DATE: April 27, 2021 REMANDED The issue of service connection for a heart disorder is remanded. The issue of service connection for sleep apnea is remanded. The issue of service connection for a respiratory disorder is remanded. REASONS FOR REMAND The Veteran served in the U.S. Navy from December 1972 to March 1974. 1. The issue of service connection for a heart disorder is remanded. 2. The issue of service connection for sleep apnea is remanded. 3. The issue of service connection for a respiratory disorder is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: In May 2020, the Board remanded the issues of service connection for a heart disorder and service connection for sleep apnea, in pertinent part, to obtain VA medical opinions as to whether the disorders were aggravated by the Veteran’s service-connected posttraumatic stress disorder (PTSD). The June 2020 opinions both state that the disorders were not permanently aggravated by PTSD. The examiner applied the incorrect standard. Permanent worsening is not required for service connection to be granted for aggravation by a service-connected disorder. Therefore, these opinions are inadequate, and remand is necessary to obtain new opinions. Remand is also necessary to obtain a new VA examination and medical opinion for the Veteran’s respiratory disorders. The June 2020 VA medical opinion stated that the Veteran may have been exposed to asbestos in service but that there was no evidence of an asbestos-related respiratory disorder. The opinion goes on to state, however, that the Veteran had both restrictive and obstructive respiratory disorders. This opinion is contradictory. Remand is necessary to obtain a new VA examination which identifies all respiratory disorders and a VA medical opinion which states whether each identified respiratory disorder was caused by service, including by in-service exposure to asbestos. 2. Obtain a VA medical opinion from a physician regarding whether the Veteran’s sleep apnea was aggravated by his service-connected PTSD. If necessary to respond to the inquiry below, schedule the Veteran for a VA examination. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address whether sleep apnea was aggravated by the Veteran’s service-connected PTSD. The examiner is advised that permanent worsening is not required for aggravation, and that an opinion based on a requirement of permanent worsening is inadequate. If sleep apnea only experiences temporary worsening due to PTSD, service connection may be granted. 3. Obtain a VA medical opinion from a physician regarding whether each identified heart disorder was aggravated by the Veteran’s service-connected PTSD. If necessary to respond to the inquiry below, schedule the Veteran for a VA examination. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address whether each identified heart disorder was aggravated by the Veteran’s service-connected PTSD. The examiner is advised that permanent worsening is not required for aggravation, and that an opinion based on a requirement of permanent worsening is inadequate. If a heart disorder only experiences temporary worsening due to PTSD, service connection may be granted. 4. Schedule the Veteran for a VA examination WITH A PULMONOLOGIST to obtain an opinion as to the nature and etiology of each identified respiratory disorder. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address the following: (a.) Identify each respiratory disorder which the Veteran currently has or has had at any point during the pendency of this appeal. If the examiner concludes that the Veteran does not have, and has not had at any point during the pendency of this appeal, a respiratory disorder, the examiner must explain why their conclusion differs from that stated in the June 2020 VA medical opinion, which states that the Veteran had restrictive lung disease and obstructive lung disease (bronchitis and pneumonia). (Continued on the next page)   (b.) Provide an opinion as to whether each identified respiratory disorder was caused by any in-service event, injury, disease, or disorder, including exposure to asbestos. Jacqueline E. Miller Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Hemphill 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.