Citation Nr: 21031890 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 18-15 514 DATE: May 24, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected chronic maxillary sinusitis and allergic rhinitis is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from September 1991 to December 2002. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In January 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ); a transcript is of record. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected chronic maxillary sinusitis and allergic rhinitis. The Veteran contends that his current obstructive sleep apnea is secondary to his service-connected sinusitis or allergic rhinitis. In the alternative, he contends that it is directly related to his active military service. The Board finds that additional development is necessary prior to adjudication. The Veteran underwent a VA contract examination in May 2015. At that time, the examiner opined that the Veteran's sleep apnea was not proximately due to or the result of his service-connected sinusitis. The Board finds this opinion is inadequate. First, the examiner did not provide any opinion with regards to aggravation. Second, in addition to being due to his sinusitis, the Veteran also has contended that his sleep apnea is due to his service-connected allergic rhinitis. However, the examiner only considered whether his sleep apnea was secondary to his service-connected sinusitis. Lastly, the rationale provided for the negative causation opinion appears to address direct service connection, not secondary service connection, as it addresses the Veteran's in-service sinus congestion and notes that the Veteran's sleep apnea is unrelated to his symptomatology. In light of the foregoing, the Board finds that a new opinion addressing secondary service connection should be obtained. Secondly, the Board also finds that an addendum opinion addressing direct service connection also should be obtained on remand. In a June 2018 opinion, a VA examiner opined that it was less likely than not that the Veteran's sleep apnea was related to his reported sleep problems in service. However, subsequent to the examination, the Veteran submitted a buddy statement in January 2020 from T.B. who reported that while living with the Veteran in service, he noticed that the Veteran would stop breathing while sleeping. Additionally, at the January 2020 hearing, the Veteran appears to have contended that his sleep apnea may be related to the septoplasty surgery he had in service. Moreover, it does not appear that the June 2018 examiner considered the May 1992 notation of a sleep disorder in the Veteran's STRs. Accordingly, the Board finds that an addendum medical opinion addressing direct service connection should also be obtained on remand. The Board acknowledges the March 2018 private opinion provided by Dr. M. In the opinion, Dr. M. opined that it was more likely than not that the physical trauma suffered during service contributed to the Veteran's sleep apnea. The Board finds that this opinion is insufficient to grant this claim. First, it is not clear what "physical trauma suffered during service" Dr. M. was referring to. While the Veteran believes he was referring to his nasal surgery in service, such is purely speculation. See January 2020 hearing transcript. Additionally, Dr. M. provided no rationale for his opinion. Moreover, there may be outstanding, relevant private treatment records. At the January 2020 hearing, the Veteran reported that he receives treatment for his breathing problems, including his service-connected disabilities for which he contends have caused his sleep apnea, from a private allergist at Potomac Hospital. However, no records from this provider are of record. Additionally, the evidence of record shows that the Veteran has received treatment for his sleep apnea from Dr. M. While records from Dr. M. from 2007-2008 are associated with the claims file, it is unclear whether there are any additional records. In a March 2018 letter, Dr. M. reported that he has treated the Veteran's sleep apnea since 2006. However, at the hearing, the Veteran reported that he receives all of his treatment through the VA. Thus, it is unclear whether there are any outstanding records from Dr. M. since 2008. Accordingly, a remand is required to allow VA to obtain authorization and request any outstanding records. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for Dr. M. and his private allergist at Potomac Hospital. Make two requests for the authorized records from the aforementioned providers, unless it is clear after the first request that a second request would be futile. 2. Obtain a VA medical opinion regarding the etiology of the Veteran's sleep apnea from a qualified medical professional. The need for a physical examination is left to the discretion of the VA examiner. The examiner must review the entire claims file and a copy of this Remand. The examiner should opine: a) Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's sleep apnea had its onset in, or is otherwise related to, active service, to include the May 1992 STR noting a sleep disorder, his August 1999 septoplasty surgery, or his complaint of cessation of breathing in service. b) Whether it is at least as likely as not that the Veteran's sleep apnea is caused or aggravated by his service-connected chronic maxillary sinusitis and/or his service-connected allergic rhinitis. In so opining, the examiner should address the articles submitted by the Veteran indicating a relationship between sinusitis, allergic rhinitis, and sleep apnea. The term "aggravation" means any incremental worsening of a disability beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should establish a baseline level of severity of the sleep apnea prior to aggravation by the service-connected disability. A complete rationale must be provided for all opinions expressed. The rationale must consider and discuss the pertinent evidence of record, to include the Veteran's lay statements. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Mortimer, 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.