Citation Nr: 21025867 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 17-40 955 DATE: April 29, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active duty service from May 1977 to August 1997. 1. Entitlement to service connection for sleep apnea is remanded. In October 2020, the Board remanded the above issue to obtain a VA opinion on the etiology of the Veteran’s sleep apnea, which was obtained in December 2020. Unfortunately, the December 2020 opinion is inadequate. In a March 2013 Statement in Support of Claim, the Veteran reported having symptoms of sleep apnea in service, which included feeling like he did not get enough sleep, restless sleep, waking up with headaches, and feeling tired for the whole day. Additionally, in his August 2019 hearing, he testified that his sleep apnea was caused by his sinus issues. In the December 2020 opinion, the VA examiner opined that it was less likely than not (less than 50 percent probability) that the Veteran’s sleep apnea had its onset during active service or is otherwise etiologically related to service. The examiner reasoned that the Veteran was diagnosed with obstructive sleep apnea based on results of a sleep study done in September 2011, which was 14 years following military service. The examiner noted that the evidence of record does not show that the Veteran had an evaluation or treatment, or complaints consistent with, a sleep disordered breathing condition such as obstructive sleep apnea during military service. The examiner then concluded that a nexus cannot be created between the Veteran’s obstructive sleep apnea and a causative event, condition, or treatment during military service. Therefore, the examiner concluded that it was less likely than not (less than 50 percent probability) that the Veteran’s sleep apnea had its onset during active service or is otherwise etiologically related to service. The December 2020 VA examiner also opined that it was less likely than not (less than 50 percent probability) that the Veteran’s sleep apnea was proximately caused and/or is aggravated by his service-connected sinusitis. The examiner reasoned that the Veteran was diagnosed with obstructive sleep apnea based on results of a sleep study done in September 2011, which was 14 years following military service. The examiner noted that obstructive sleep apnea is caused by collapse of the upper airways during sleep, resulting in intermittent cessation of breathing. Sinusitis affects the lining of the sinus cavities, and does not directly contribute to collapse of the upper airways. Being overweight or obese is a major and primary risk factor for developing obstructive sleep apnea. At the time of his sleep study in September 2011, the examiner noted that the Veteran’s BMI was 27.4, which is categorized as overweight. Therefore, the examiner opined that it was at least as likely as not that the Veteran’s overweight condition is the proximate cause for his obstructive sleep apnea. The examiner also noted that there is also no objective evidence of record that the Veteran’s obstructive sleep apnea has worsened beyond that which may be expected over time, such as due to the effects of aging. In addition, medical literature is inconsistent with regard to the prevalence of sleep-related disordered breathing (e.g. obstructive sleep apnea) in patients with chronic rhinosinusitis. Therefore, the examiner concluded that it was less likely than not (less than 50 percent probability) that the Veteran’s sleep apnea was proximately caused by and/or is aggravated by his service-connected sinusitis. The Board finds the December 2020 VA opinions inadequate. While the December VA examiner noted that the Veteran reported longstanding difficulty with insomnia, disruptive sleep patterns, fitful sleep, waking frequently with headaches, dry mouth, waking with choking and gagging, and daytime fatigue with hypersomnolence when discussing his medical history, the VA examiner did not address the Veteran’s lay statements when rendering his opinion. Specifically, the examiner did not address the Veteran’s March 2013 reports of having symptoms of sleep apnea in service, which included feeling like he did not get enough sleep, restless sleep, waking up with headaches, and feeling tired for the whole day. Given the above, a remand is necessary to obtain another opinion on the nature and etiology of the Veteran’s sleep apnea that takes into account the Veteran’s lay statements. The matters are REMANDED for the following action: 1. Obtain a medical opinion from a qualified clinician to determine the nature and etiology of the Veteran’s sleep apnea. The claims file must be made available to and reviewed by the examiner. The examiner is asked to respond to the following: a) Whether it is at least as likely as not (50 percent probability or higher) that the Veteran’s sleep apnea had its onset during active service or is otherwise etiologically related to service. b) Whether it is at least as likely as not (50 percent probability or higher) that the Veteran’s sleep apnea was proximately caused and/or is aggravated by his service-connected sinusitis. The examiner must address the Veteran’s lay statements that he has had symptoms of sleep apnea in service, which included feeling like he did not get enough sleep, restless sleep, waking up with headaches, and feeling tired for the whole day. The examiner must provide a complete rationale for any and all conclusions reached. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information that would be needed, if possible, to make an opinion. 2. After completing the above action, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claim must be readjudicated. GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. E. Grossman, 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.