Citation Nr: 21030149 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 16-46 947 DATE: May 18, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Marine Corps from February 1966 to June 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, the Board remanded the Veteran's case and it has now been returned to the Board for review. In October 2020, the Board remanded the Veteran's claim to obtain a VA medical opinion concerning whether the Veteran's sleep apnea was proximately due to or aggravated by his service-connected PTSD. The examiner was asked to consider the Veteran's statements that he slept okay/better and that his nightmares were reduced when using his CPAP machine. The examiner was also asked to consider the studies cited and discussed by the Veteran's representative in the October 2020 brief discussing a possible association between PTSD and sleep apnea. Unfortunately, the Board finds that remand is required for new opinions. The examiners made no mention of the studies referenced by the Veteran's representative. The more recent examiner also did not address the Veteran's statements that he experienced a reduction in his PTSD symptoms when using his CPAP machine and whether that supports interplay between PTSD and sleep apnea as requested by the Board's remand. Accordingly, a new opinion is required. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition, the RO obtained an opinion concerning direct service connection due to the contention that the Veteran's sleep apnea may be related to exposure to contaminated water in Camp Lejeune and exposure to dioxins in Vietnam. The Veteran's DD Form 214 shows that the Veteran received a Vietnam Service Medal with three stars and Vietnam Campaign Medal with device, and was separated from service at Camp Lejeune. The February 2021 VA examiner provided a negative opinion noting that there was no credible medical evidence to support a causal link between sleep apnea and any hazardous exposure, but did not address the articles referenced by the Veteran's representative in the October 2020 brief. Accordingly, a new opinion is required. Given the claims that the Veteran's service at Camp Lejeune may be related to his sleep apnea and without verification of how long he was at Camp Lejeune, the Board finds that the Veteran's service personnel records should be obtained and associated with the record. The matter is REMANDED for the following action: 1. Request the Veteran's service personnel records. 2. Request a new opinion from a suitably qualified examiner regarding the etiology of the Veteran's sleep apnea. The claims folder must be made available for review. The examiner must address the following: (a.) Opine whether it is at least as likely as not that the Veteran's sleep apnea was caused by active service, to include exposure to contaminants at Camp Lejeune and herbicide exposure in Vietnam. In doing so, the examiner must address the articles referenced by the Veteran's representative in the October 2020 brief. (b.) Opine whether it is at least as likely as not that the Veteran's sleep apnea was proximately due to or aggravated by his service-connected PTSD. In doing so, the examiner must discuss statements that he slept better, and his nightmares were reduced, when using his CPAP machine; and studies cited and discussed by the Veteran's representative in the October 2020 brief discussing a possible association between PTSD and sleep apnea. A full and complete rationale must be provided for any opinion reached. 3. Thereafter, readjudicate the remanded issue, and if still denied, return the matters to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Seay, 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.