Citation Nr: 21031643 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 18-08 011 DATE: May 24, 2021 REMANDED The claim of entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 2006 until July 2016. This matter comes to the Board of Veterans' Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In July 2020, the Veteran testified in a hearing before the Board. A transcript of the hearing has been included in the electronic claims file and has been reviewed. The record contains a January 2018 VA medical opinion into this matter. The opinion addresses certain aspect of the Veteran's claim, but not all aspects. As such, a remand is warranted for issuance of an addendum medical opinion. See Walsh v. Wilkie, 32 Vet. App. 300 (2020) (obesity, although itself not a compensable disability, could constitute an intermediate step in demonstrating a service connection on a secondary basis, to include direct causation and/or aggravation). The Veteran's representative has questioned the qualifications of the VA examiner with regard to sleep disorders. Along with the addendum report, the VA examiner should provide a resume/curriculum vitae (CV) detailing experience and qualifications. See Nohr v. McDonald, 27 Vet. App. 124 (2014). The matter is REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the claim, to include any outstanding VA treatment records. All records/responses received must be associated with the electronic claims file. 2. Obtain a copy of the VA examiner's resume/CV. Once obtained, associate the information with the electronic claims file and provide a copy to the Veteran and his representative. 3. Return the case to the VA examiner who conducted the January 2018 examination, or to a suitable substitute, for issuance of an addendum medical opinion. After reviewing the claims file, the examiner should comment on the following questions: (a). Is it at least as likely as not (i.e., probability of 50 percent or more) that OSA had its onset during service? In answering (a) discuss the Veteran's testimony in the July 2020 Board hearing, in which he indicates that the same symptoms that led to the June 2017 impression of OSA, and to the eventual December 2017 sleep study and diagnosis, existed during service. Even though the service treatment records do not note OSA, is it nevertheless at least as likely as not that the in-service symptoms he describes were the same symptoms leading to the OSA diagnosis approximately 18 months later? (b). If the answer to (a) is negative, is it at least as likely as not that OSA is related to a disease, event, or injury during service? (c). If the answers to (a) and (b) are negative, is it at least as likely as not that OSA is due to or caused by service-connected disability, such as hypertension, psychiatric disability, or bulimia nervosa and associated obesity? (d). If the answers to (a), (b), and (c) are negative, is it at least as likely as not that OSA has been aggravated (i.e., permanently or temporarily worsened beyond the natural progress) by service-connected disability, such as hypertension, psychiatric disability, or bulimia nervosa and associated obesity? In answering (c) or (d), address the finding in the January 2018 VA opinion, that sleep problems prior to service discharge related to anxiety. Does this indicate that OSA may have related to service-connected psychiatric disability? In answering (c) or (d), also address what impact obesity from the service-connected eating disorder has on OSA. The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. Please explain in detail any opinion provided and the supporting rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. 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). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee, 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.