Citation Nr: 21042719 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-17 119 DATE: July 13, 2021 REMANDED Entitlement to service connection for an obstructive sleep apnea disability, to include as secondary to a service-connected post-traumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1968 to August 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2017 rating decision issued by the Department of Veterans Affairs VA Regional Office. In September 2020, the Veteran testified before the undersigned Veterans Law Judge during a Board video conference hearing. This matter was previously before the Board in February 2021 but was remanded to obtain VA medical opinions for his disability. The Veteran was scheduled for a VA examination in March 2021 and his claim was denied in an April 2021 supplemental statement of the case (SSOC). This matter is again before the Board for adjudication. 1. Entitlement to service connection for an obstructive sleep apnea disability, to include as secondary to service-connected post-traumatic stress disorder (PTSD) is remanded. Unfortunately, the Board finds that additional remand is warranted to obtain an adequate medical opinion to address the etiology of the Veteran's disability. A review of his service treatment records reflect he was treated for multiple sore throats in 1969 and diagnosed with tonsillitis. Similarly, in March 1972, he was seen again for a sore throat and was noted to have exudative tonsillitis. The Veteran further reported having ear, nose, and throat trouble in a January 1972 separation report of medical history, and his separation examination indicates he had throat trouble that was constantly congested. During the Board hearing, the Veteran testified that after 1971 his stopped breathing became more noticeable and he was experiencing sleep interruptions. He reported having problems staying asleep, falling sleep, and had night terrors. He also reported having anxiety while trying to fall asleep. The Veteran was provided with a VA examination in March 2021 and a medical opinion was provided for both direct and secondary service connection. Upon review of the medical opinion for direct service connection, the Board finds that the VA examiner did not consider any of the Veteran's in-service treatment related to his treatment for sore throats, tonsillitis, or his endorsement of having ear, nose, throat issues during service. Instead, the rationale was based solely on the absence of a sleep diagnosis in service. The VA examiner also did not consider any of the Veteran's lay statements during the September 2020 Board hearing regarding his symptoms shortly after leaving service. In this regard, the Board finds that the March 2021 VA medical opinion for direct service connection is not supported by the medical or lay evidence and is not supported by an adequate rationale. As such, the Board finds that the March 2021 VA medical opinion for direct service connection is inadequate for adjudication purposes. The Board further finds that the VA medical opinion for secondary service connection lacks an adequate rationale. Specifically, the VA examiner generally states that mental disorders can cause sleep problems like insomnia but do not cause obstructive sleep apnea. Regarding the aggravation component of a secondary service connection claim, the VA examiner simply states there is no pathophysiological pathway for the major depressive disorder to aggravate the Veteran's sleep apnea. The Board notes that if a medical opinion does not clearly address the relevant facts and medical science, the Board "is left to rely on its own lay opinion, which it is forbidden from doing." Stefl v. Nicholson, 21 Vet. App. 120, 124, (2007) (Citing Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991)). Based on the foregoing, the Board finds that the March 2021 VA medical opinion for direct and secondary service connection are insufficient for the Board to adjudicate the merits of the claim. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, the Board finds that a remand is warranted to obtain adequate medical opinions to address the etiology of the Veteran's obstructive sleep apnea disability. The matters are REMANDED for the following action: 1. Obtain any outstanding VA or private treatment records related to the Veteran's obstructive sleep apnea and associate them with the claims file. 2. After, schedule the Veteran for a VA examination. The claims file, including a copy of this remand, should be made available to the examiner, who should review it in conjunction with the prior examination and should note that review in the report. The VA examiner is requested to provide an opinion to the following questions: a.) Is the Veteran's obstructive sleep apnea disability at least as likely as not (50 percent probability or greater) related to any in-service event, injury, or illness, to include his in-service treatment for sore throats, congested throats, and tonsillitis? b.) Is the Veteran's obstructive sleep apnea disability at least as likely as not (50 percent probability or greater) proximately caused by the Veteran's service connected acquired psychiatric disorders to include PTSD? c.) Is the Veteran's obstructive sleep apnea disability at least as likely as not (50 percent probability or greater) aggravated by the Veteran's service connected acquired psychiatric disorders to include PTSD? A complete and detailed rationale for these opinions should be provided for every opinion requested by the examiner. 3. After, readjudicate the claim. If the benefit sought on appeal remains denied, furnish the Veteran with a supplemental statement of the case (SSOC) and provide him with an appropriate opportunity to respond. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Xiong, 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.