Citation Nr: 21042091 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 18-17 914 DATE: July 12, 2021 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for erectile dysfunction (ED), to include as secondary to PTSD is remanded. REASONS FOR REMAND The Veteran served on active duty with the Army from July 17, to December 16, 2001, from September 2004 to January 2006, and from August 2008 to October 2009. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the RO, in adjudicating the Veteran's claim in the January 2018 rating decision, indicated that the claim was previously denied and, therefore, was one that required new and material evidence in order to be reopened. However, a review of the file shows that the November 2017 rating decision was never final. In December 2017, within a year of the November 2017 rating decision, the Veteran submitted Disability and Benefits Questionnaires completed by his treating medical professional. Thus, new and material evidence was submitted prior to the expiration of the appeal period and is considered as having been filed in connection with the original claim. See 38 C.F.R. § 3.156 (b). Therefore, the Board finds the Veteran's claims on appeal have been active since he filed the original claim for service connection for OSA and ED in October 2017. The Veteran testified before the undersigned Veterans Law Judge at a video conference hearing in March 2020. A transcript of the proceeding has been associated with the claims file. The Board remanded the Veteran's claims in a May 2020 decision. The claims were remanded for a medical opinion that addressed whether the Veteran's OSA and ED were aggravated beyond natural progression by his service-connected PTSD. The RO obtained the addendum medical opinions in July 2020. Although the Board finds that the RO has substantially complied with the May 2020 Board remand directive, the Board finds that further development is needed to properly adjudicate the Veteran's claims. See Stegall v. West, 11 Vet. App. 268 (1998); see also 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. 1. Entitlement to service connection for obstructive sleep apnea (OSA), to include as secondary to posttraumatic stress disorder (PTSD) is remanded. 2. Entitlement to service connection for erectile dysfunction (ED), to include as secondary to PTSD is remanded. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Board notes that in his October 2017 claim for service connection, the Veteran specifically claimed that his PTSD and ED are secondary to his service-connected PTSD. However, during his November 2017 VA examinations, the Veteran suggested that his conditions were directly related to his service. As for the OSA, the Veteran stated that after two tours in Iraq, he experienced high stress, and his sleep was always fractured due to the intensity of war. He further stated that his sleep was constantly interrupted, his stress levels were high, his sleeping patterns were abrupt, and he was constantly around high noise levels. The Veteran noticed that he was always in a bad mood and felt exhausted, tired, irritable, and never properly rested. During his VA examination for ED, the Veteran stated that he has had problems with ED since he got out of the Army in 2009. He believes his ED is due to his service in Iraq with high levels of stress and fractured sleep patterns. The Board cannot make a fully-informed decision on the issues of service connection for OSA and ED because no VA examiner has opined whether his claimed conditions are directly related to his service. Additionally, the Board finds that an addendum medical opinion in needed as to whether the Veteran's OSA and ED are proximately due to or the result of his service-connected PTSD. The November 2017 VA examiner opined that the Veteran's ED and OSA are less likely than not due to his service-connected PTSD. The rationale for the examiner's opinion as to ED is that there is limited medical evidence in the Veteran's file to note that his ED is a result of the PTSD. The Board finds that this rationale is inadequate as there is no analysis as to why the Veteran's ED is not related to his PTSD. The examiner also fails to describe the "limited medical evidence" that negates the Veteran's claim. The Board finds that the rationale offered for the Veteran's OSA claim is inadequate as well. The examiner explained that the Veteran's OSA is due to a 31 percent body mass index (BMI) noted at the time of his May 2017 sleep study. However, a review of the Veteran's sleep study shows a BMI of 25 percent. Furthermore, the examiner checked the Veteran's weight as normal at the time of the November 2017 VA examination. Accordingly, the Board finds that an addendum medical opinion is needed to more accurately and thorouhgly addresses whether the Veteran's ED and OSA are proximately due to or the result of his service-connected PTSD. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's obstructive sleep apnea is at least as likely as not related to his service in Iraq. When rendering an opinion, the examiner is asked to specifically consider the Veteran's statements made to the VA examiner in November 2017 noting that his sleep was constantly interrupted, he experienced high stress levels, his sleeping patterns were abrupt, and he was constantly around high noise levels. The examiner is also asked to render an opinion as to whether the Veteran's obstructive sleep apnea is proximately due to his service-connected posttraumatic stress disorder. Any opinion expressed should be accompanied by a complete rationale. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's erectile dysfunction is at least as likely as not related to his service in Iraq. When rendering an opinion, the examiner is asked to consider the Veteran's statements made to examiner in November 2017. The Veteran stated that he has had problems with erectile dysfunction since 2009 after returning from Iraq. The Veteran contends that his high stress and fractured sleep contributed to his condition. The examiner is also asked to render an opinion as to whether the Veteran's erectile dysfunction is proximately due to his service-connected posttraumatic stress disorder. Any opinion expressed should be accompanied by a complete rationale. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Hartford, 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.