Citation Nr: 21040121 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 18-23 234A DATE: July 2, 2021 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2003 to January 2007, including overseas service in Iraq. The Veteran appeals a September 2017 rating decision by the Agency of Original Jurisdiction (AOJ). A Board of Veterans' Appeals (Board) hearing was held in May 2021. A transcript is of record. The Veteran is diagnosed with sleep apnea. See April 2018 treatment records. The Veteran contends his sleep apnea is secondary to his service-connected posttraumatic stress disorder (PTSD). See October 2017 notice of disagreement (NOD); May 2021 Board Hearing Tr. at 2. The Veteran also contends his symptoms started after returning from Iraq and have been the same since service. See April 2018 VA Form 9; May 2021 Board Hearing Tr. at 3, 5. August 2019 VA treatment records note the Veteran has sleeping difficulty due to physical pain. The Veteran is also service-connected for a right ankle and back condition. Overall, the Veteran has not been afforded an examination and no etiology opinion has been rendered. As such, remand is required to obtain opinions that cover all theories of entitlement. The matter is REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his sleep apnea that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, schedule the Veteran for an examination to determine the nature and etiology of his sleep apnea. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. After the record review and examination of the Veteran, the examiner is asked to respond to the following inquiries: Is it at least as likely as not that the Veteran's sleep apnea was incurred in, or otherwise related, to his time on active service, to include but not limited to exposure to any environmental hazards while serving in Iraq? (the examiner is to consider the Veteran's symptoms since returning from Iraq). Is it at least as likely as not that the Veteran's sleep apnea was CAUSED by his service-connected PTSD? Is it at least as likely as not that the Veteran's sleep apnea was AGGRAVATED by his service-connected PTSD? Is it at least as likely as not that the Veteran's sleep apnea was CAUSED by his service-connected right ankle condition? Is it at least as likely as not that the Veteran's sleep apnea was AGGRAVATED by his service-connected right ankle condition? Is it at least as likely as not that the Veteran's sleep apnea was CAUSED by his service-connected back condition? Is it at least as likely as not that the Veteran's sleep apnea was AGGRAVATED by his service-connected back condition? Is the etiology OR pathophysiology of the Veteran's sleep apnea not conclusive as to this particular Veteran? In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. After the above development has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board, if otherwise in order. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Zheng, 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.