Citation Nr: 21026492 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-48 330 DATE: May 3, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from January 1987 to July 1990. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2015 by a Department of Veterans Affairs (VA) Regional Office (RO).The Veteran appeared for a hearing before the undersigned Veterans Law Judge in November 2018. A transcript of the hearing is of record. This matter was previously remanded by the Board in June 2019 for additional development. It is now before the Board for further appellate review. 1. Entitlement to service connection for sleep apnea is remanded. The Veteran asserts that he is entitled to service connection for sleep apnea as secondary to his service-connected sarcoidosis. More specifically, the Veteran asserts that the steroids therapy he received to treat his sarcoidosis caused weight gain which led to his development of sleep apnea. The Veteran appeared for a VA examination in January 2020. The examiner opined that the Veteran's sleep apnea was less likely than not related to his sarcoidosis steroid therapy. The examiner explained that risk factors for obstructive sleep apnea are age, male gender, obesity, and upper airway abnormalities, not sarcoidosis. The examiner stated that the Veteran's risk factors of advancing age and male gender outweigh the singularity of obesity. The Board finds that the January 2020 medical opinion is inadequate. Though the examiner concluded that the Veteran's sleep apnea is more likely related to advancing age and his male gender, he provided no rationale for this conclusion. Further, the examiner determined that upper airway abnormalities are a risk factor for sleep apnea, but did not acknowledge that the Veteran's sarcoidosis is rated as a lung disability, nor did he state whether this disability itself is therefore an upper airway abnormality that may result in sleep apnea. Thus, before the Board can make a fully informed decision on the issue of entitlement to service connection for sleep apnea, a new opinion is required. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate examiner (but not the examiner who provided the January 2020 opinion) as to whether the Veteran's sleep apnea is related to his sarcoidosis or whether it is related to weight gain resulting from his use of steroids to treat his sarcoidosis. The examiner is to review the Veteran's claims file, including this remand, prior to offering the requested opinion. The examiner is to answer the following questions: a) Is it at least as likely as not that the Veteran's sleep apnea is secondary to his sarcoidosis? That is, is the Veteran's sleep apnea proximately due to, the result of, or aggravated by his service-connected sarcoidosis? In answering this question, the examiner is to state whether the Veteran's sarcoidosis results in an upper airway abnormality that was previously identified as a risk factor for sleep apnea. b) Is it at least as likely as not that the Veteran's weight gain from his use of steroids caused or aggravated his sleep apnea? In answering this question, the examiner is to state whether the Veteran's weight gain from his use of steroids was a substantial factor in causing his sleep apnea, and whether the Veteran's sleep apnea would not have developed but for his weight gain from his use of steroids. A complete rationale for all requested opinions is required. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. K. Hall, 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.