Citation Nr: 21025930 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 17-40 567 DATE: April 29, 2021 REMANDED Entitlement to service connection for sleep apnea to include as secondary to service-connected PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 2005 to September 2012. Entitlement to service connection for obstructive sleep apnea to include as secondary to service-connected PTSD is remanded. The Board finds that the matter must be remanded to obtain another medical opinion, as the VA opinions are inadequate for adjudicative purposes. According to the December 2014 VA examination, the examiner opined that the Veteran’s obstructive sleep apnea was an “incidental” finding, however, the Veteran specifically requested a sleep study due to symptoms that she experienced. No opinion was provided as to the etiology of her sleep apnea. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (finding that the probative value of a medical opinion comes from whether it is factually accurate, fully articulated, and has sound reasoning for the conclusion, not from the mere fact that the claims file was reviewed); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that “[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.”). The examiner also failed to consider the Veteran’s lay statement and statements from G.E., regarding the onset of her symptoms of obstructive sleep apnea. The June 2015 VA examination agreed with the December 2014 examiner’s rationale and relied solely on that opinion in rendering a negative nexus opinion. Therefore, the July 2015 VA opinion is also inadequate. Additionally, in the December 2014 VA examination, the examiner opined that the Veteran’s insomnia is proximately due to service-connected PTSD. The examiner also stated the following: “nearly 30 percent of patients with insomnia have sleep apnea.” Since the Veteran’s insomnia is associated with her service-connected PTSD, (see e.g., January 2015 Rating Decision Codesheet) the examiner’s rationale raises the theory that her obstructive sleep apnea is secondary to service-connected PTSD. Therefore, a medical opinion is warranted to determine whether the Veteran’s obstructive sleep apnea is caused and/or aggravated by service-connected PTSD. The matters are REMANDED for the following action: 1. Obtain all outstanding private and/or VA treatment records and associate them with the claims folder. Specifically, the RO should obtain a copy of the July 2013 Sleep Study Report. 2. Thereafter, schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) from a medical professional with appropriate expertise. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. The examiner should opine to the following: Whether it is at least as likely as not (50 percent or greater possibility) the Veteran’s obstructive sleep apnea had its onset in service or is etiologically related to service. Whether it is at least as likely as not that the Veteran’s obstructive sleep apnea is (1) caused by the service-connected PTSD, or (2) that the Veteran’s service-connected PTSD has caused additional functional impairment of the obstructive sleep apnea (e.g., a worsening of sleep apnea symptoms beyond those expected by the baseline level of disability, even if temporary). In doing so, the examiner should consider the following: • July 2013 Sleep Study Report (conducted within one year from discharge of service); • October 2015 Sleep Study Report; • November 2015 Lay Statement from G.E.; and • November 2015 Lay Statement from the Veteran. The Board notes that in a recent decision, the United States Court of Appeals for Veterans Claims held that the term “aggravation” requires that a service-connected disability condition (PTSD) causes a “functional increase in the severity” of the nonservice-connected disability (OSA). Garner v. Tran, U.S. App. Vet. Claims LEXIS 81 (Jan. 26, 2021). A complete rationale for all medical opinions is required. The examiner should 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). If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In doing so, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After completing the above action, re-adjudicate the claim. If the claim remains denied, the Veteran and her representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Adeleke, T. 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.