Citation Nr: 21040683 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 16-07 609 DATE: July 6, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1974 to August 1977 and from September 1990 to July 1991. This matter is before the Board of Veterans' Appeals (Board) on appeal of a February 2011 rating decision. The Veteran appeared at a hearing before the undersigned Veterans Law Judge in March 2017. The claim was last before the Board in February 2020, whereupon the Board issued a decision denying entitlement to service connection for the above listed condition. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In a Joint Motion for Remand (JMR) in November 2020, the Court vacated the Board's decision of the appealed issue and remanded the issue to the Board with directions to further develop the file in support of the Veteran's claim. In its JMR, the Court noted that the Board erred by finding that VA's duty to assist was satisfied by a September 2018 VA examination. The Court indicated that the medical examiner did not provide a well-reasoned rationale for opining that the Veteran's sleep apnea was less likely than not incurred in or caused by service. It was noted that although the examiner stated that the Veteran had reported trouble with sleep apnea during service in 1991, in the medical history section of the examination report, the examiner did not explain in his rationale why, despite these reports, it would be speculative to ascribe service connection. The Court remanded the issue and stated that the Board was required to obtain a new VA medical opinion. The Court also stated that the examiner should address the Veteran's testimony that she started noticing problems sleeping and breathing in 1991 while serving in Desert Storm, as well as addressing her reports of sleeping problems, including snoring since 1991, as noted in the January 2010 Statement in Support of Claim. Based on the foregoing, and to comply with the JMR, further action in connection with the underlying service connection claim concerning the Veteran's sleep apnea, to include as secondary to service-connected PTSD is warranted. A remand for a new opinion is necessary. The matters are REMANDED for the following action: Return the Veteran's claim folder to the examiner who conducted the September 2018 VA sleep apnea examination for an addendum opinion. If an additional examination is deemed necessary, one should be scheduled. (The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic, and requests flexibility and understanding in affording the Veteran an opportunity to report for an examination). If the prior examiner is not available, the claims file must be forwarded to another examiner to obtain the requested opinion. The examiner is to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any current diagnosed sleep apnea disorder had its onset during, or is otherwise etiologically related to, the Veteran's active duty service. Separately, provide an opinion as to whether it is at least as likely as not that sleep apnea was caused or aggravated by the service-connected PTSD. In rendering the opinion, the VA examiner is to explain why it would be speculative to ascribe service connection for the Veteran's condition, as noted in the September 2018 VA medical opinion, in addition to addressing the Veteran's testimony that she started noticing problems sleeping and breathing in 1991 while serving in Desert Storm, as well as her reports of sleeping problems, including snoring, since 1991, as noted in the January 2010 Statement in Support of Claim, per the Court's request. A complete rationale must be provided for all opinions expressed and conclusions reached. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A-L Evans, 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.