Citation Nr: 21025868 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 16-63 349 DATE: April 29, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1984 to August 1995. The Veteran testified at an April 2017 Board hearing before the undersigned; a copy of the transcript is associated with the record The Board most recently remanded the sleep apnea claim in December 2020 for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). The claim must be remanded again because the January 2021 VA medical opinion is inadequate. The examiner offered negative opinions as to direct and secondary service connection. However, the examiner did not provide a medical opinion, or rationale, as to whether the Veteran’s currently diagnosed obstructive sleep apnea has been aggravated by her service-connected asthma disability. Additionally, the examiner did not specifically address the Veteran’s credible reports of sleep problems during service, including waking up and gasping for breath. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician to determine the likely etiology of the Veteran’s obstructive sleep apnea. Copies of all pertinent records must be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) one should be scheduled. After reviewing the claims file, the examiner is asked to answer the following questions: (a) Is it at least as likely as not (50 percent probability) that any currently diagnosed obstructive sleep apnea was incurred in or is otherwise related to service? The examiner must specifically address the Veteran’s credible reports of sleep problems during service, including waking up gasping for breath. The lack of diagnostic testing during service CANNOT be the basis of a negative opinion. (b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that the Veteran’s obstructive sleep apnea is proximately due to (caused by) the Veteran’s service-connected disabilities; specifically asthma? (c) If (b) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed obstructive sleep apnea has been aggravated by the service-connected asthma? The examiner is informed that aggravation here is defined as any increase in disability. The examiner must provide reasons for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, he or she should explain why this is so and what, if any, additional evidence would be necessary before an opinion could be rendered. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.E. Bresler, 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.