Citation Nr: 21025604 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 16-33 598 DATE: April 28, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1996 to April 2004. The Veteran was scheduled to testify at a hearing in March 2019 before a Veterans Law Judge (VLJ) of the Board of Veterans’ Appeals (Board/BVA); however, he did not attend the hearing. Therefore, his hearing request is deemed withdrawn. See 38 C.F.R. §§ 20.702(d), 20.704(d) (2018). In this circumstance, without justifiable explanation (“good cause”) for his absence, the Board is not obligated to offer him another opportunity for a hearing. See also July 2020 Veteran Correspondence. The Veteran has not, however, been afforded a VA examination to determine the nature and etiology of his claimed sleep apnea, which he alleges began during service or alternatively was caused or is aggravated by his service-connected PTSD. See, e.g., July 2020 Veteran Statement, November 2020 Veteran’s Representative Brief. VA’s duty to assist includes providing a medical examination for an opinion when needed to decide a claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). Accordingly, this claim is REMANDED for the following action: 1. Contact the Veteran and inquire whether there are any additional records concerning his claim needing to be obtained. If there are, obtain these additional records following proper procedure and protocol (38 C.F.R. § 3.159(c)) and appropriately notify him and his representative if unable to obtain records that he identifies (38 C.F.R. § 3.159(e)). 2. After obtaining all additional treatment or other relevant records, provide the Veteran a VA examination by a qualified clinician for a medical opinion concerning the nature and etiology of his sleep apnea. A copy of this remand and all relevant medical and other records must be made available to the examiner. The examiner should review the pertinent evidence, including the Veteran’s lay assertions regarding the history of this claimed disability. Based on review of the Veteran’s medical records, his lay statements regarding the development and treatment of his sleep apnea, and a review of all other relevant evidence in the claims file, including, again, a complete copy of this remand, the examiner should answer the following questions: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s sleep apnea was caused OR is aggravated by his service-connected PTSD? If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of sleep apnea by the Veteran’s service-connected PTSD. (b) If not, is it at least as likely as not (a 50 percent or greater probability) the Veteran’s sleep apnea began during his service from October 1996 to April 2004 or is otherwise related or attributable to his service? The mere absence of evidence of treatment for sleep apnea in the Veteran’s service treatment records (STRs) cannot, alone, be sufficient rationale for providing an unfavorable opinion, certainly not since this claim also is predicated on the alternative notion that service-connected disability (PTSD) is causing or aggravating it, so not based exclusively on what occurred during service but also during the many years since service. The examiner is also advised that the Veteran is competent to report his symptoms and history and his reports must be specifically considered in formulating any opinions. If the examiner rejects the Veteran’s reports, the examiner must provide reason for doing so.   Rationale for the opinion therefore is essential, regardless of whether favorable or unfavorable to this claim, preferably citing to evidence in the file supporting conclusions and/or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Mukherjee 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.