Citation Nr: 21030560
Decision Date: 05/19/21	Archive Date: 05/19/21

DOCKET NO. 20-04 600
DATE: May 19, 2021

REMANDED

Entitlement to service connection for obstructive sleep apnea, to include as due to posttraumatic stress disorder (PTSD), is remanded.

REASONS FOR REMAND

The Veteran served on active duty from January 1964 until October 1966.

This matter was most recently before the Board in February 2021 when it was remanded for further development. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998).

1. Entitlement to service connection for obstructive sleep apnea, to include as due to posttraumatic stress disorder (PTSD), is remanded.

In February 2021, the Board remanded the claim on appeal for a VA examination to address the likelihood that the Veteran's sleep apnea was caused or aggravated by his service-connected posttraumatic stress disorder (PTSD).

The Board finds the March 2021 VA medical opinion inadequate for adjudication purposes. The VA examiner opined that the Veteran's sleep apnea was less likely than not caused by his PTSD; however, the examiner acknowledges that, based on the Veteran's reports of snoring since leaving active service, the condition's onset would have coincided with onset of his PTSD. The examiner did not provide a clear rationale for why the Veteran's sleep apnea was more likely caused by the Veteran's other risk factors, such as his biological sex, age, neck circumference, and obesity, despite both conditions beginning after leaving active service.

Accordingly, this claim must be remanded for an addendum medical opinion.

The matters are REMANDED for the following action:

1. Return the record to the VA examiner who offered the March 2021 addendum opinion as to the etiology of the Veteran's sleep apnea. The record and a copy of this Remand must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the record and the Remand have been reviewed.

Following a review of the record, the examiner should provide an opinion as to whether OSA is at least as likely as not (a 50 percent or greater probability) caused or aggravated by the Veteran's service-connected PTSD. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline.

If the examiner still concludes that it is less likely than not (a less than 50 percent probability) that his sleep apnea was caused or aggravated by his service-connected PTSD the examiner must address why this is so if the onset of the Veteran's sleep apnea coincided with the onset of their PTSD.

Additionally, the examiner is asked to provide a medical explanation for why the Veteran's other risk factors, such as his biological sex, age, neck circumference, and weight, are more likely causes for developing sleep apnea than his PTSD, which has been acknowledged by medical research to be significant risk factor for developing sleep apnea.

The examiner must provide a complete rationale for all opinions and conclusions reached.

 

 

K. Anderson

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Hicks, 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.