Citation Nr: 21032068
Decision Date: 05/25/21	Archive Date: 05/25/21

DOCKET NO. 15-11 797
DATE: May 25, 2021

REMANDED

Entitlement to service connection for sleep apnea, to include on a secondary basis, is remanded.

REASONS FOR REMAND

This appeal was previously before the Board in October 2020, at which time the Board remanded this claim in order for the Agency of Original Jurisdiction (AOJ) to obtain a medical opinion that addressed whether the Veteran's sleep apnea was caused or aggravated by a service-connected disability. At that time, the Board noted that the VA opinion of record was inadequate because the rationale in support of the opinion, e.g., that the Veteran's sleep apnea was not due to or aggravated by the service-connected psychiatric disability because it predated the psychiatric disability, was not material to the issue of aggravation. See April 2019 VA opinion. 

In November 2020, the same VA examiner provided another medical opinion wherein he stated that the Veteran's sleep apnea was not proximately due to or a result of the medications taken for his service-connected disabilities, noting that "up to date" does not list Sertraline and Mirtazapine as causative factors for obstructive sleep apnea. 

Unfortunately, the November 2020 VA opinion is inadequate because it is not responsive to the questions asked in the October 2010 Board remand. Indeed, the examiner was not asked to address whether there was causative relationship between the Veteran's sleep apnea and medications taken for his service-connected psychiatric disability. Instead, the Board requested an opinion on whether the Veteran's sleep apnea was caused or aggravated by his service-connected disabilities, neither of which was addressed by the November 2020 opinion. Stegall v. West, 11 Vet. App. 268, 271 (1998).

Given the foregoing, the Board finds a remand is needed to obtain an adequate VA opinion. 

The matters are REMANDED for the following action:

1. Request that an appropriate medical professional review the claims file and provide an addendum opinion regarding the Veteran's sleep apnea. The claims file must be reviewed, and the examination report must reflect that such review was accomplished. The need for an additional examination is left to the discretion of the examiner. 

The examiner is requested to provide an opinion as to the following: 

(a)	Is it at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea was caused by his service-connected psychiatric disability or any other service-connected disability?

(b)	Is it at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea was or is aggravated by his service-connected psychiatric disability or any other service-connected disability, to include any manifestations thereof? 

Aggravation means any increase in disability or additional impairment of earning capacity of the nonservice-connected disability. 

If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. 

The examiner should address the lay and medical evidence of record, including the articles submitted by the Veteran in support of his claim. 

The examiner must provide a complete, well-reasoned rationale for each opinion offered. 

 

 

M. Donohue

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Turnipseed, 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.