Citation Nr: 21032888 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 16-41 884 DATE: May 28, 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 March 2008 to August 2008 and from May 2009 to May 2010. This matter comes before the Board of Veterans Appeals (Board) on appeal from a July 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript has been associated with the electronic claims file. The Board previously considered this appeal in March 2020 and remanded the issues of entitlement to service connection for a back condition (claimed as spinal deterioration) and entitlement to service connection for sleep apnea for further development including scheduling VA examinations. The case returned to the Board for further appellate review. Subsequently, the appeal of entitlement to service connection for a back condition (claimed as spinal deterioration) was granted in a February 2021 rating decision. Because that decision represents a full grant of the benefit sought, the issue is not before the Board. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. Entitlement to service connection for sleep apnea The Veteran contends his currently diagnosed sleep apnea is the result of his active military service. Military personnel records confirm service in Iraq and Kuwait from July 2009 to April 2010. See Veteran's DD-214. Treatment records show that the Veteran was diagnosed with mild obstructive sleep apnea in December 2020 after a sleep study. In an August 2010 post deployment health re-assessment, self-assessment questionnaire, he rated his health as good. He denied any sleep disabilities. However, he noted been concerned with sand, dust and smoke from burning trash or feces while deployed in Iraq. In his July 2016 statement, the Veteran stated experiencing trouble sleeping after serving in Iraq. An April 2013 VA treatment note the Veteran sleep 4 to 5 hours a night, sometimes interrupted. In May 2019 the Veteran reported problem with sleep, excessive snoring, as noted by his wife but has not had a sleep study. The Veteran testified at a February 2020 Board hearing that he hardly sleeps 3 to 4 hours a day and always felt that he has a hard trouble breathing when he is sleeping. The Veteran indicated that he has requested sleep studies to VA in the past, but he has been ignored. He also testified that while been deployed, he was mostly fatigued, but he "just got used to it." When he was at home, his wife told him he was snoring too much. The Veteran's wife also testified that they have been married for 10 years, since the Veteran was in service. She believes her husband has a sleep problem as he snores and sometimes, she doesn't hear him breathing. A December 2020 sleep study shows the Veteran reported sleep complaints of snoring, excessive daytime sleepiness, wake up gasping/choking. The Veteran was diagnosed with mild obstructive sleep apnea. In December 2020, the Veteran underwent a VA examination to determine the etiology of his current sleep disorder. After a review of the Veteran's records, the VA examiner opined the Veteran's sleep apnea was less likely than not incurred in or caused by an in-service injury, event, or illness. The rationale provided was that the Veteran did not seek treatment for the claimed sleep apnea condition during service, that all chronological service records reviewed show no notation of sleep apnea. After taking into account the Veteran's wife statements and her account of the Veteran's symptoms during the military, as well as the Veteran's lay statements, the examiner stated that the evidence does not link the Veteran to sleep apnea during service. The Board finds this opinion does not offer a thorough rationale for the conclusions drawn. Additionally, the examination does not address exposure to sand, dust and smoke in service. When VA undertakes to provide a VA examination or obtain a VA medical opinion, it must ensure that the examination or opinion is adequate, see Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007), which in this context requires that an examination report sufficiently inform the Board of a medical expert's judgment on a medical question, rely upon accurate factual premises, including the Veteran's lay statements regarding symptomatology, and present a fully articulated, sound rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Unfortunately, the medical opinions obtained on remand were once again inadequate for adjudicative purposes, and this issue must be remanded in order to obtain sufficient a report. The matters are REMANDED for the following action: 1. Obtain addendum opinions regarding the etiology of the Veteran's sleep apnea. The medical professional should obtain from the Veteran and record in the report a complete history regarding the onset and continuity of sleep apnea symptoms. An examination of the Veteran is not required unless the medical professional designated to provide the below opinions finds one is necessary Following a complete review of the evidence of record, and with consideration of the Veteran's statements, please opine on the following: (a) Determine whether it is at least as likely as not (50 percent probability or higher) that the Veteran's sleep apnea began during or is etiologically related to his active duty service. The examiner must comment on the lay statements of symptoms in service and the exposure to sand, dust, or smoke from burning trash or feces in Iraq. The examination report should specifically state that a review of the record was conducted. Any and all diagnostic testing deemed necessary should be performed prior to finalizing the report. The examiner should provide a complete rationale for all opinions provided, which involves a detailed discussion of the reasoning behind each conclusion and does not rely on conclusory statements. (Continued on the next page) If an opinion cannot be provided without resorting to mere speculation, the examiner should identify all medical and lay evidence considered in this conclusion, fully explain why this is the case and identify what additional evidence (if any) would allow for a more definitive opinion. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Romero-Sanchez, 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.