Citation Nr: 21027356 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 16-32 577 DATE: May 5, 2021 REMANDED The issue of service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran had active service from December 1984 to November 1988 and from February 1991 to March 1991. This matter was previously before the Board of Veterans' Appeals (Board) in June 2020 when the issue of service connection for OSA was remanded for further development. This matter remains not ready for appellate review and the Board must again remand the appeal. Stegall v. West, 11 Vet. App. 268 (1998). The issue of entitlement to service connection for OSA is remanded. The matter is REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: Pursuant to the June 2020 Board remand, the Veteran was afforded a VA examination in November 2020. However, the VA examination is not adequate because it does not address whether: (1) the Veteran's service-connected posttraumatic stress disorder and associated depression and anxiety CAUSED OR AGGRAVATED (i.e. WORSENED) his OSA, and; (2) the Veteran's service-connected deviated nasal septum, chronic sinusitis, and allergic rhinitis CAUSED OR AGGRAVATED (i.e. WORSENED) his OSA. The remand directives follow. 2. Return this case to the November 2020 VA examiner and request a further addendum. If that examiner is no longer available, the file may be reviewed by an appropriately-qualified VA medical examiner. If necessary, the Veteran should be scheduled for a VA examination. The November 2020 VA examiner noted that the Veteran's sleep study completed in 2013 and 2014 diagnosed him with mild OSA, and he was discharged from active duty in 1991. The examiner stated that due to the extensive time gap from the time the Veteran was discharged service to the time he complained of snoring, a causal relationship cannot be established. However, the EXAMINER MUST EXPRESS AN OPINION AS TO WHETHER TOGETHER OR SEPARATELY, THE VETERAN'S SERVICE-CONNECTED PTSD, DEVIATED NASAL SEPTUM, SINUSITIS, AND ALLERGIC RHINITIS AGGRAVATE (i.e. WORSENS) HIS OSA. All evidence and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. The examiner MUST respond to the following: (a.) The examiner MUST opine as to whether the Veteran's OSA was caused or aggravated (worsened) by the Veteran's service-connected PTSD, to include associated symptoms of depression and anxiety, and if so, state to what extent. (b.) The examiner MUST opine as to whether the Veteran's OSA was caused or aggravated (worsened) by the Veteran's service-connected sinusitis and/or rhinitis, and if so, state to what extent. (c.) If the examiner finds that the Veteran's OSA was not caused or aggravated by his service-connected PTSD, or symptoms thereof, sinusitis, or rhinitis, the examiner MUST, to the extent possible, opine as to the likely etiology of the Veteran's OSA. A thorough explanation must be provided for the opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, s/he should expressly indicate this and provide supporting rationale as to why the opinions cannot be made without resorting to speculation. The examiner is advised that by law, the mere statement that the claims folder was reviewed and/or the examiner has expertise is not sufficient to find the examination/opinion sufficient. 3. Following the review and any additional development deemed necessary, re-adjudicate the claim. If the claim is not granted in entirety, issue an appropriate supplemental statement of the case (SSOC) and forward the claim to the Board for adjudication. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims (Court) for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Timothy T. Emmart The Board's remand in this case is binding only with respect to this matter. This action is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.