Citation Nr: 21032688 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 19-12 806 DATE: May 27, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1966 to May 1969, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2021, the Veteran testified at a Virtual Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file and has been reviewed. This appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c). 38 U.S.C. § 7107(b)(1). Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim and to afford him every possible consideration. Entitlement to service connection for sleep apnea The Veteran asserts he has sleep apnea secondary to his service-connected diabetes. The Veteran was provided a VA examination in April 2019. The examiner diagnosed sleep apnea but opined it was less likely than not proximately due to or the result of his service-connected diabetes disability. The examiner explained that there is no scientific literature that suggest diabetes causes sleep apnea and no evidence of causation. However, the examiner did not address whether the Veteran's diabetes aggravated his sleep apnea condition. Importantly, a medical examination or opinion that fails to address whether a service-connected disability aggravated the claimed disability is inadequate to inform the Board on the issue of secondary service connection. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). The Board also notes the Veteran's private treatment record in April 2021 where a nurse practitioner opined that "sleep apnea has been shown through multiple research studies to be related to cardiac arrhythmias, hypertension, thyroid disorders, diabetes, seizures, hypersomnolence and insomnia." While the private opinion from the nurse practitioner supports the Veteran's claim, the Board finds the opinion provides very little probative value and affords it little weight in the analysis of the Veteran's claim because it offers only conclusions without supporting data or the essential rationale for the opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) ("[An adequate] medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." (citing Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007)). Accordingly, the Board must remand the matter of service connection for sleep apnea to obtain an addendum opinion on whether the Veteran's service-connected disabilities aggravated his sleep apnea disability. The matter is REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA or private treatment records. To expedite this action, the Veteran is encouraged to submit any additional VA or private medical records in his possession that we do not have. 2. Obtain an addendum opinion from the April 2019 VA sleep apnea examiner. If that examiner is not available, another examiner with appropriate qualifications may provide the opinion. Another VA examination of the Veteran is not required unless deemed necessary by the VA examiner. Following consideration of the evidence of record (both lay and medical) and all evidence obtained during the examination, if applicable, the examiner is asked to address the following: 3. Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that sleep apnea was caused by the Veteran's military service. 4. Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was proximately caused by any of his service-connected disabilities. 5. Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea was aggravated beyond its natural progression by any of his service-connected disabilities. The examiner should consider and discuss, among other things, the April 2021 private treatment record that indicates multiple studies are available showing that sleep apnea is related to diabetes. In providing the etiology opinions, the examiner should be aware of the fact that the Court in Ward v. Wilkie, 31 Vet. App. 233 (2019) held that a "permanent worsening" of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation may include temporary worsening of a disability). In other words, the Court changed the definition of aggravation to now include temporary flare-ups of the claimed condition caused by a service-connected disability. 6. After the above development has been completed, and after any additional development as required, readjudicate the issues on appeal. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher M. Davidson 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.