Citation Nr: 21041512 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 17-21 577 DATE: July 9, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1989 to January 1996 and May 1996 to April 2010. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in December 2013 by a Department of Veterans Affairs (VA) Regional Office. In April 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. At such time, the undersigned held the record open for 60 days for the submission of additional evidence, which was received in May 2021. Entitlement to service connection for obstructive sleep apnea. The Veteran contends that his currently diagnosed obstructive sleep apnea (see February 2017 VA examination) had its onset during his military service. In this regard, in April 2021 statements: (1) the Veteran's spouse, C.P., indicated that, since she married him in October 2000, she noticed that he snored significantly more than anyone else she knew, he could not stay awake, and he woke up tired; (2) T.L. reported that he had known the Veteran for almost 20 years, and during their time on active duty, he observed him snoring extremely loud, and (3) C.C. noted that he served with the Veteran for approximately eight months in 2005, and the Veteran constantly snored and had difficulty functioning during the day due to his lack of quality sleep. Additionally, a May 2021 buddy statement from C.L. reflected that he met the Veteran in 2001 and, for the 20 years that he had known him, he had a significant snoring problem. In February 2017, the Veteran was afforded a VA examination, at which time it was noted that he had a diagnosis of obstructive sleep apnea as reflected by a February 2013 sleep study. However, while the examiner noted the Veteran's report that he noted the Veteran's report of snoring and feeling tired in 2009, she opined that such disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In support thereof, she simply reported that there was no indication of sleep apnea occurring during service. In contrast, a May 2021 private treatment record from Dr. E.G. reflects an assessment that the Veteran had an "obstructive sleep apnea diagnosis long-standing in nature with snoring sleep difficulty that dates back to his military career snoring documented previously." The Board finds that the February 2017 VA examiner's opinion and Dr. E.G.'s May 2021 assessment are inadequate to adjudicate the Veteran's claim. In this regard, the February 2017 VA opinion does not appear to consider all relevant evidence. Specifically, as noted previously, the Veteran, his spouse, and his fellow service members reported symptoms of snoring and tiredness during service. Further, his service treatment records (STRs) include an undated, but appearing to have been completed in 2005 in accordance with the Veteran's reported birthdate and age, PHA Health History Questionnaire that reflects his affirmative response to whether in the past few months he "often had difficulty sleeping (trouble falling asleep or frequent awakening)" and "often felt tiredness which lasts for a few hours after arising." Additionally, a January 2010 Report of Medical Assessment reveals that, in response to "Do you have any other questions or concerns about your health?" the Veteran stated, "yes sleep apnea." Additionally, in January 2013, the Veteran reported symptoms, to include snoring, fatigue, and early morning headaches, that had been present over the past several years, which gave rise to the scheduling of his sleep study that took place the following month and diagnosed obstructive sleep apnea. Additionally, while Dr. E.G. noted a long-standing history of obstructive sleep apnea and symptoms of snoring and sleep difficulty during military service, he did not specifically relate such symptoms to the onset of sleep apnea during service, or specifically address the etiology of such disorder. Consequently, the Board finds that a remand is necessary in order to obtain an addendum opinion addressing the etiology of the Veteran's obstructive sleep apnea. The matters are REMANDED for the following action: Forward the record, to include a copy of this remand, to an appropriate medical professional to offer an opinion as to the etiology of the Veteran's sleep apnea. Specifically, following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's currently diagnosed obstructive sleep apnea had its onset in, or is otherwise related to, his military service, to include his reports of snoring, difficulty sleeping, and tiredness therein. In offering such opinion, the examiner should consider and address the following evidence: An undated, but appearing to have been completed in 2005 in accordance with the Veteran's reported birthdate and age, PHA Health History Questionnaire that reflects his affirmative response to whether in the past few months he "often had difficulty sleeping (trouble falling asleep or frequent awakening)" and "often felt tiredness which lasts for a few hours after arising;" A January 2010 Report of Medical Assessment reflecting that, in response to "Do you have any other questions or concerns about your health?" the Veteran reported, "yes sleep apnea;" April 2021 and May 2021 statements from the Veteran's spouse and former service members who reported witnessing his snoring and tiredness during service; A January 2013 private treatment record wherein the Veteran reported symptoms, to include snoring, fatigue, and early morning headaches, that had been present over the past several years, which gave rise to the scheduling of his sleep study that took place the following month and diagnosed obstructive sleep apnea; A May 2021 private treatment record from Dr. E.G. reflecting an assessment that the Veteran had an "obstructive sleep apnea diagnosis long-standing in nature with snoring sleep difficulty that dates back to his military career snoring documented previously." A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Koria B. Stanton, 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.