Citation Nr: 21041330 Decision Date: 07/08/21 Archive Date: 07/08/21 DOCKET NO. 18-35 480 DATE: July 8, 2021 REMANDED Service connection for obstructive sleep apnea (OSA) is remanded. Service connection for acid reflux is remanded. Service connection for gastroesophageal reflux disease (GERD) is remanded. Service connection for dysphagia is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served active duty in the United States (U.S.) Navy from February 1977 to February 1981 and the U.S. Air Force from February 2004 to August 2004, May 2006 to November 2006, January 2007 to September 2007, January 2008 to April 2009, and May 2009 to September 2009. The Veteran appeared for a hearing before the undersigned Veterans Law Judge (VLJ) in February 2020. The hearing transcript is associated with the claims file. An April 2020 Board decision denied, in pertinent part, service connection for OSA, service connection for acid reflux, service connection for GERD, and service connection for dysphagia. The Veteran appealed the decision to the U.S. Court of Appeals for Veterans Claims (Court). In February 2021, the Court issued an order that partially vacated the Board's April 2020 decision and remanded the matters on appeal for adjudication consistent with the Joint Motion for Partial Remand (JMPR) by the parties. REASONS FOR REMAND 1. Service connection for OSA The February 2021 JMPR remanded the claim to address a private doctor's critique of the adequacy of the March 2019 VA examiner's rationale. The Board requests an addendum opinion regarding the etiology of the Veteran's OSA, to include addressing medical literature in relation to the Veteran's individual circumstances. 2. Service connection for acid reflux 3. Service connection for GERD 4. Service connection for dysphagia The February 2021 JMPR remanded the claims for an examination addressing the Veteran's claimed acid reflux, GERD, and dysphagia. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's OSA. An in-person examination is not required unless deemed necessary by the clinician. The clinician is asked to provide a response: (a.) Is it at least as likely as not the Veteran's OSA manifested during service or is otherwise related to service? The clinician must consider the Veteran's lay statements regarding the onset of his sleep symptoms. See February 2020 hearing testimony. By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. (b.) Is it at least as likely as not the Veteran's OSA is proximately due to service-connected PTSD? (c.) Is it at least as likely as not the Veteran's OSA is aggravated beyond its natural progression by service-connected PTSD? If citing to medical literature, the clinician is asked to discuss the findings in relation to the Veteran's individual circumstances. The clinician must consider: (i) medical literature submitted by the Veteran in July 2018, "PTSD Severity Linked to Higher Risk of Sleep Apnea in Veterans" and "OSA and PTSD among OEF/OIF/OND veterans," (ii) December 2019 private medical opinion from Dr. B.V., (iii) January 2020 DBQ from Dr. E.W., and (iv) May 2020 addendum medical opinion from Dr. B.V. 2. Schedule the Veteran for a VA examination with an appropriate clinician for acid reflux, GERD, and dysphagia. The clinician is asked to provide a response: (a.) Identify any esophageal diagnoses found during the appeal period, to include claimed acid reflux, GERD, and dysphagia. (b.) For any diagnosis identified, is it at least as likely as not the disability manifested during service or is related to service? The clinician must consider the Veteran's lay statements regarding the onset of his esophageal symptoms. See February 2020 hearing testimony. By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. (c.) Is it at least as likely as not the Veteran's OSA is proximately due to service-connected PTSD? (d.) Is it at least as likely as not the Veteran's OSA is aggravated beyond its natural progression by service-connected PTSD? KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Winkler, 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.