Citation Nr: 21042771 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-31 731 DATE: July 13, 2021 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected PTSD is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from August 1966 to July 1968. This matter originally came before the Board of Veterans' Appeals (Board) from a July 2014 rating decision of the Department of Veterans' Affairs (VA) Regional Office (RO). In January 2019, the Board remanded this case for additional development. Entitlement to service connection for sleep apnea, to include as secondary to service-connected PTSD is remanded. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Veteran was afforded an addendum opinion for his sleep apnea in October 2019. The examiner opined the Veteran's sleep apnea is at least as likely as not aggravated beyond its natural progression by his service-connected PTSD. The Veteran has stated his frequent nightmares caused by his PTSD prevent him from wearing his CPAP or BiPAP machine while sleeping. The examiner stated that this may aggravate his sleep apnea. The VA obtained a second addendum opinion by the same examiner in April 2020, which conflicts with his previous opinion. The examiner's opinion in April 2020 was that the Veteran's sleep apnea is not caused or aggravated by his service-connected PTSD. He noted again that the Veteran says his frequent nightmares caused by his PTSD prevent him from wearing his CPAP or BiPAP machine while sleeping. However, the examiner additionally explained that sleep apnea "is due to airway obstruction during sleep" and that although "PTSD may impact his sleep, it will not cause sleep apnea." There was no additional rationale as to why he opined the Veteran's nightmares from PTSD do not aggravate his sleep apnea. The Board finds that the opinions for aggravation are too conclusory for the Board to determine the basis for the opinion or how the opinion was formed. Additionally, as both opinions were provided by the same examiner, an addendum opinion should be provided by a physician specializing in sleep medicine. The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file. 2. Obtain an addendum opinion by a physician (M.D) specializing in sleep medicine for the Veteran's sleep apnea. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. The examiner should provide opinions that respond to the following: a. Is it at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea is caused by his service-connected PTSD? b. Is it at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea is aggravated by his PTSD? (Aggravation here means the disability increased in severity beyond its natural progression.) The examiner must consider and address the Veteran's March 2014 lay statement where he describes his PTSD symptoms and their impact on his sleep, his wife's March 2014 lay statement where she reports witnessing the Veteran's experiences with interrupted sleep due to nightmares, and the June 2017 private medical opinion relating the Veteran's sleep apnea to his PTSD. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Papacalos, 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.