Citation Nr: 21032585
Decision Date: 05/27/21	Archive Date: 05/27/21

DOCKET NO. 18-20 415
DATE: May 27, 2021

REMANDED

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

REASONS FOR REMAND

The Veteran served on active duty from September 1993 to November 1995. The Veteran testified at a hearing before the undersigned in July 2020.

The claim is remanded to obtain an adequate medical opinion. The Veteran testified that she has experienced trouble sleeping since service. See July 2020 Hearing Transcript. Service treatment records indicate that the Veteran did report at least one sleep disturbance in service. See July 1995 Service Treatment Note. 

May 2017 and March 2018 VA opinions are inadequate as they do not address aggravation as to whether the Veteran's OSA was aggravated or worsened by her service-connected PTSD and fibromyalgia. 

 The matters are REMANDED for the following action:

1. Contact the Veteran, and, with the Veteran's assistance identify and obtain copies of any pertinent medical or VA treatment records and add them to the claims file. If VA attempts to obtain any outstanding records which are unavailable, the Veteran should be notified.

2. After completion of the foregoing, forward the claims file and copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion on the likely etiology of the diagnosed sleep apnea. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled.

After reviewing the claims file, the examiner is asked to answer the following questions:

(a) Is it at least as likely as not (50 percent probability) that any currently diagnosed sleep apnea was incurred in or is otherwise related to service? In answering this, the examiner must specifically consider the Veteran's statements that she complained of sleep problems in service, never felt rested and was told by others that she snored loudly. 

(b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed OSA is proximately due to (caused by) the Veteran's service-connected PTSD or fibromyalgia disability?

(c) If (b) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed OSA disability has been aggravated by the Veteran's service-connected PTSD or fibromyalgia disability?  The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation.

The examiner must provide reasons for each opinion given. If the examiner is unable to provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made.

3. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum.

 

M.E. Larkin

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	T. Jarman, 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.