Citation Nr: 21025792 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 13-08 114 DATE: April 29, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1982 to September 2002. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2016, February 2018, and March 2020, the Board remanded this issue for further evidentiary development. As explained below, remand is again necessary as there has not been substantial compliance with the Board’s prior remand directives. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141 (1999). Entitlement to service connection for sleep apnea is remanded. The Veteran contends that his sleep apnea had onset during active duty. Specifically, he reports that, during active duty, he had out of control snoring, daytime fatigue, and he would fall asleep at any time during the day. In buddy statements submitted in 2010 and 2011, the fellow servicemembers noted that the Veteran snored very loudly and that others sometimes had to leave the vicinity to get sleep. In a January 2011 statement, the Veteran’s wife reported that they had been married 28 years. She stated that he loudly snored and it sounded like he stopped breathing during the night. In addition, the Veteran complained of being tired. In a January 2011 statement, the Veteran’s daughter reported that he would fall asleep on the couch, snore loudly, and make choking sounds. The Board concludes that remand is required to obtain and adequate addendum etiological opinion. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A VA examiner must consider a veteran’s testimony when formulating an opinion. McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016). An examiner cannot ignore lay evidence and base his or her opinion that there is no relationship to service on the absence of in-service corroborating medical records. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). Here, a September 2020 VA examination and opinion was obtained. The Veteran reported onset in 1984, during service, and diagnosis in 2010. The examiner opined that the sleep apnea was less likely as not incurred or related to service, noting the lack of complaints or a diagnosis in the Veteran’s service treatment records. The examiner noted that, although the Veteran’s wife complained of his snoring and stopping breathing, snoring is not a diagnosis of sleep apnea, only a symptom. The examiner cited to a website page from the Sleep Foundation that indicated that snoring does not mean a person has sleep apnea. The Board finds the examiner’s explanation inadequate as it did not address the other buddy statements regarding snoring during service and did not fully address the statements within the Veteran’s wife’s statement. Additionally, the examiner did not address other relevant portions of the Sleep Foundation website page. The same page, for example, noted that snoring three times per week or more, loud snoring, and snoring with gasping sounds were all potential signs of sleep apnea. The buddy statements noted each of these symptoms. Accordingly, remand is required for an addendum opinion. In remanding this matter, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers seen for signs, symptoms, or treatment of sleep apnea since service discharge. Make two requests for the authorized records from all identified sources unless it is clear after the first request that a second request would be futile. 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s sleep apnea. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with his diagnosed sleep apnea. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician should provide an opinion, with supporting rationale, as to: Whether the Veteran's sleep apnea at least as likely as not (1) had its onset in service, or (2) is otherwise related to an in-service injury, event, or disease. Consider whether in-service symptoms described by the Veteran and others (buddy statements), such as tiredness and snoring, at least as likely as not represent the onset of sleep apnea in service and indicate whether such symptoms are more likely than not due to other causes—explain. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): If any medical history is rejected, a complete explanation is required. 3. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.M., 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.