Citation Nr: 21027462 Decision Date: 05/05/21 Archive Date: 05/05/21 DOCKET NO. 18-41 944 DATE: May 5, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to in-service environmental exposures (asbestos, hydrogen sulfide, crank case oil, petroleum, soot, stack smoke, fumes, jet exhaust, and aviation fuel) and/or service-connected depression, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1963 to March 1967. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in December 2017 and March 2018. In March 2021, the Veteran testified at a Board Central Office hearing before the undersigned Veterans Law Judge in Washington, DC. A transcript of the hearing is of record. Entitlement to service connection for OSA, to include as secondary to in-service environmental exposures and/or service-connected depression, is remanded. A VA medical opinion dated in March 2018 and May 2019 did not discuss whether the Veteran's claimed OSA was secondary to his service-connected depression. In a September 2020 medical opinion, a private physician's assistant certified (PA-C) opined it was more likely than not that the mental traumas suffered during the Veteran's military service as noted in his record caused, contributed to, and aggravated his OSA. Based on incomplete findings in the VA medical opinions as well as the lack of rationale contained in the private medical opinion, the AOJ should obtain an additional VA medical opinion to clarify the etiology of the Veteran's claimed OSA. The matter is REMANDED for the following actions: 1. Obtain a VA medical opinion to clarify the etiology of the Veteran's claimed OSA from an appropriate examiner. If an opinion cannot be provided without an examination, one should be provided. The electronic claims file must be made available to the examiner, and the examiner must specify in the report that the file has been reviewed. Based on a review of the electronic claims file and the Veteran's lay assertions, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's OSA was caused or aggravated (worsened) by the service-connected depression (to include medications taken to treat it). The examiner should also acknowledge and discuss the Veteran's lay assertions, lay statements from family members, findings in the March 2018 and May 2019 VA examination reports/medical opinions, treatise evidence, and the September 2020 private medical opinion. Rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner 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(s). The Veteran is hereby advised that failure to report for any scheduled VA examination without good cause shown may have adverse effects on his claim. 38 C.F.R. § 3.655 (2020). 2. After completing the above actions and any other necessary development, the claim on appeal must be re-adjudicated, taking into consideration all relevant evidence associated with the record since the July 2018 SOC. If the benefit on appeal remains denied, an SSOC must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. D. Deane, 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.