Citation Nr: 21025796 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 17-47 429 DATE: April 29, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1978 to October 1982. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In January 2020, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. Most recently, in December 2020, the Board remanded the claim to address the Veteran’s reports of snoring and discuss her specific medical history and symptoms. Entitlement to service connection for sleep apnea. The Veteran contends that her sleep apnea is related to surgery that she had during active duty, which involved removing a cyst and some bone from her right maxillary jaw. The Veteran underwent a VA examination in January 2021. The examiner opined that the Veteran’s current (A) complex sleep apnea, (B) severe obstructive sleep apnea, and (C) treatment emergent central sleep apnea were less likely than not incurred during or due to service to include evidenced by reported snoring or related to maxillary surgery while in service. The Board regrets the additional delay but finds that remand is necessary to afford the Veteran full consideration of her claim. Although the opinion addressed snoring, it continues to fail to provide a detailed rationale regarding whether the Veteran’s in-service oral surgery as likely as not led to her current sleep apnea. The Board previously found that, without consideration of the Veteran’s specific oral surgery, the 2015 opinion stating that oral surgery was not listed as a risk factor for sleep apnea was insufficient rationale. The most recent opinion notes the surgery but does not address the contended connection, and further, the opinion relies on the lack of objective evidence; this is not the correct standard. A new addendum opinion is needed to provide detailed rationale considering her specific medical history, as directed in the prior Board remands. Accordingly, the matter is REMANDED for the following action: 1. Update VA treatment records. 2. Thereafter, request an addendum opinion from an appropriate examiner. For each type of sleep apnea, the examiner should provide an opinion on whether it is as likely as not (50/50 probability or greater) that it is related to her active duty service. The Veteran reported that following in-service surgery to remove a radiolucent lesion and reposition the right maxillary alveolar ridge, she experienced symptoms related to sleep apnea. The examiner is asked to address the Veteran’s specific medical history and provide a full discussion on symptoms related to the above surgery. All opinions must be supported with a detailed explanation that supports the conclusion. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Wilson, 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.