Citation Nr: 22007014 Decision Date: 02/08/22 Archive Date: 02/08/22 DOCKET NO. 17-24 994 DATE: February 8, 2022 REMANDED Entitlement to service connection for an acquired psychiatric disability, to include posttraumatic stress disorder (PTSD) is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1979 to June 1985, and from May 2009 to April 2010. These matters come before the Board of Veterans Appeals (Board) from a March 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2021, the Veteran testified during a video hearing before the undersigned Veterans Law Judge; a transcript of the hearing is of record. The Board finds that a remand is necessary to obtain a new VA medical examination regarding the Veteran's claimed psychiatric disorder. The Veteran underwent a VA mental health examination in July 2015. The examiner diagnosed the Veteran with Alcohol Use Disorder and Unspecified Anxiety Disorder, but concluded he did not have PTSD. The examiner stated that the Veteran's reported stressorshearing mortar attacks near where he was stationed, and hearing small arms fire hit his convoyswere not "specific stressor[s] that would definitively meet Criteria [sic] A for a diagnosis of PTSD." The examiner did not explain why the reported stressors did not meet Criterion A, nor did they acknowledge a May 2015 statement in which the Veteran did describe a specific incidentin which he saw multiple wounded soldiers after a mortar hit a latrine. The examiner also did not address the etiology of the Veteran's Unspecified Anxiety disorder, despite this condition being within the scope of his claim. See Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009). The examiner only said, in a March 2016 addendum, that they "[could] not state that the Unspecified Anxiety Disorder is related to the Veteran's service experience without resorting to mere speculation," without indicating whether this inability was due to a limitation in their own expertise or because no clinician could determine the most likely etiology of the disorder. Due to the above, the July 2015 VA examination is inadequate. VA has a duty to ensure that any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is adequate where it is based upon consideration of the full medical history and describes a disability in sufficient detail so that the Board's evaluation will be fully informed. Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). The medical opinion must support its conclusions with sufficient data and reasoning. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301-304 (2008). If a medical examination is inadequate, a remand is warranted to obtain an adequate examination. Because the Veteran has argued that his sleep apnea is secondary to PTSD, the sleep apnea claim is inextricably intertwined with the claim for an acquired psychiatric disability, and must also be remanded. Moreover, the Board finds the July 2015 VA examination inadequate with respect to the Veteran's sleep apnea disorder. The July 2015 VA examiner noted that the Veteran has obstructive sleep apnea, a diagnosable condition with a known etiology. The examiner, however, did not provide an opinion as to whether the Veteran's sleep apnea began in or is otherwise related to his military service. Thus, VA must provide the Veteran with an etiological opinion. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate clinician, who has not already provided an opinion in this case, regarding the nature and etiology of the Veteran's psychiatric disabilities. If the clinician believes an in-person or telehealth examination is necessary, one should be scheduled. After reviewing the entire claims file, including a copy of this remand, the examiner should answer the following: (a) What psychiatric conditions does the Veteran currently have? If the examiner finds that the Veteran does not have PTSD, this finding must be reconciled with the past diagnosis of PTSD in the Veteran's medical records. (b) For each diagnosed psychiatric condition, is it at least as likely as not (50 percent probability or greater) that the condition had its onset during active service? (c) For each diagnosed psychiatric condition, is it at least as likely as not that the condition was caused or aggravated by an event that occurred during active service, such as exposure to mortar attacks? (d) If any of the Veteran's psychiatric conditions is unrelated to service, what is the likely etiology of that condition? A complete and fully explanatory rationale must be provided for any opinion offered, citing any record evidence or medical literature relied upon. The examiner must give due weight to the Veteran's lay testimony. If an opinion cannot be rendered without resorting to speculation, the examiner must explain why. 2. Obtain an opinion from an appropriate clinician regarding the nature and etiology of the Veteran's sleep apnea. If the clinician believes an in-person or telehealth examination is necessary, one should be scheduled. After reviewing the entire claims file, including a copy of this remand, the examiner should answer the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran's sleep apnea had its onset during active service, or is related to any event, injury, or disease incurred during active service? (b) Is it at least as likely as not that the Veteran's sleep apnea was caused or aggravated by an active psychiatric condition, to include PTSD? (c) If the Veteran's sleep apnea is unrelated to his active duty service or any service-connected disability, what is its likely etiology? (Continued on the next page) A complete and fully explanatory rationale must be provided for any opinion offered, citing any record evidence or medical literature relied upon. The examiner must give due weight to the Veteran's lay testimony. If an opinion cannot be rendered without resorting to speculation, the examiner must explain why. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shermila Sundquist 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.