Citation Nr: 21029928 Decision Date: 05/17/21 Archive Date: 05/17/21 DOCKET NO. 16-09 389 DATE: May 17, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1990 to July 1991, to include service in Southwest Asia. The Veteran had additional inactive service with the Alabama National Guard. For her meritorious service, the Veteran was awarded (among other decorations) the Southwest Asia Service Medal. This matter comes before the Board of Veterans' Appeals on appeal from an October 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in March 2020. At that time, the Board granted one service connection claim, denied a second, and remanded the matter listed above. Entitlement to service connection for obstructive sleep apnea is remanded. A remand is necessary to obtain a well-supported medical opinion addressing whether the condition claimed is due to service. The Board previously remanded the Veteran's claim seeking such an opinion; though such an opinion was obtained in November 2020, the Board agrees with the Veteran's representative that it is inadequate for rating purposes. The Board's previous remand directed that the Veteran undergo a VA examination, and that the examiner opine as to whether the Veteran's claimed sleep apnea is related to her active service, or is secondary to her service-connected disabilities. The November 2020 examiner determined that an examination was not necessary (which, given the evidence of record and the state of the Covid-19 pandemic at that time, the Board agrees with that conclusion). However, the opinions provided contained no rationale whatsoever. For the direct service connection question, the examiner stated "[t]he lay statements state that he snored after service, but there is no evidence that exposure during the gilf [sic] war causes OSA. Due to this, his snoring after service would be irrelevant to his OSA." Putting aside the fact that the examiner used the wrong gender pronouns for this female Veteran, these two sentences are wholly inadequate for the Board to make a determination. The secondary opinions may even be worse in terms of lack of rationale. Given these shortcomings, the Board shall again remand the Veteran's claim in order to seek an adequate opinion. The matter is REMANDED for the following action: 1. Obtain the Veteran's VA treatment records dated from August 2018 and thereafter and associate them with her claims file. 2. Obtain an opinion from an appropriate examiner (but not the examiner who offered the November 2020 opinion) as to whether the Veteran's sleep apnea is related to her active service or to her service-connected disabilities. Only schedule the Veteran for an examination if deemed necessary by the examiner to answer the Board's questions. After reviewing the claims file, the examiner is to provide an opinion whether it is at least as likely as not (50 percent probability or greater) that obstructive sleep apnea was incurred in service or is otherwise etiologically related to service, particularly from exposure to environmental hazards during the Persian Gulf War. The examiner is to consider and discuss the lay statements about the Veteran's sleeping patterns or snoring during and after service; the Service Treatment Record (STR) from March 1994 notating respiratory difficulty; and 2011 sleep study where the Veteran described different symptoms over the 12 years before that. The examiner must also state whether sleep apnea at least as likely as not (50 percent probability or greater) is secondarily related to either service-connected PTSD or IBS, based on service-connected disability as either causing or chronically aggravating the obstructive sleep apnea. The examiner must consider the internet medical literature the Veteran had previously sent. Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Lyons, 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.