Citation Nr: 21032721 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 18-35 078 DATE: May 27, 2021 REMANDED Service connection for obstructive sleep apnea, to include as secondary to diabetes mellitus and ischemic heart disease, is remanded. REASONS FOR REMAND The Veteran had active service from January 1967 to January 1970. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in April 2021. A transcript of that hearing has been added to the record. Service Connection Obstructive Sleep Apnea The Board finds that additional development is required before the claim on appeal is decided. The Veteran has asserted that he has sleep apnea was caused or chronically worsened by a service-connected disability, to include weight gain caused by such. In a November 2017 letter from the Veteran's primary care physician, Dr. D.C. At that time, Dr. S.C. noted that he suspected that the Veteran's sleep apnea was related to his reported weight gain. However, Dr. D.C. used speculative language, and did not provide a supporting rationale for the conclusion reached. As such, the private medical opinion is inadequate for adjudication purposes. In March 2018, the Veteran was afforded a VA examination. at that time, the Veteran's sleep apnea diagnosis was confirmed. The VA examiner opined that the Veteran's sleep apnea was not caused by his DM. The examiner merely noted that DM was not a risk factor for the development of sleep apnea. However, the examiner did not discuss whether weight gain associated with the Veteran's DM caused or aggravated his sleep apnea. As such, the opinion is inadequate for adjudication purposes. Therefore, the Board finds that the Veteran should be afforded a new VA examination to determine the nature and etiology of his diagnosed sleep apnea. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of his sleep apnea. The claims file must be made available to, and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's sleep apnea was caused or aggravated (chronically worsened) by a service-connected disability, to specifically include weight gain related to the Veteran's diabetes mellitus and/or physical limitations caused by the Veteran's ischemic heart disease and/or diabetic neuropathy. If it is determined that the Veteran's weight gain was not the result of a service-connected disability, then the examiner must provide a fully supported rationale for any such finding. A detailed rationale for all opinions expressed must be provided. 2. Confirm that the VA examination report and all medical opinions provided comport with this remand, and undertake any other development determined to be warranted. 3. Then, readjudicate the appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.