Citation Nr: 22012172
Decision Date: 03/02/22	Archive Date: 03/02/22

DOCKET NO. 16-52 569
DATE: March 2, 2022

REMANDED

Entitlement to service connection for sleep apnea, to include as secondary to major depressive disorder is remanded.

REASONS FOR REMAND

The Veteran had active military service from July 1976 to November 1976 and active air service from December 1976 to October 1978. 

This case comes before the Board of Veterans' Appeals (Board) on appeal of a March 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

This case was previously before the Board, most recently in November 2021, at which time the issues on appeal were remanded for additional development. The case has now been returned to the Board for further appellate action. 

The Board finds that a remand is again necessary for substantial compliance with the November 2021 remand directives. See Stegall V. West, 11 Vet. App. 268 (1998).

The Veteran contends that his sleep apnea is secondary to his service-connected major depressive disorder.

An addendum opinion provided by a VA examiner was associated with the Veteran's claim file in December 2021 in which the examiner failed to address the Veteran's article submission, "December; Study links depression with sleep apnea." The article states that people with depression are five times more likely to have a breathing-related sleep order. The examiner clearly ignored the prior November 2021 Board remand directives to discuss the article. Therefore, a new opinion is needed on remand.

The matters are REMANDED for the following action:

1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file.

2. Forward the Veteran's claims file to the VA Medical Center for an addendum medical opinion, by a physician or nurse practitioner who has not previously examined the Veteran or provided an opinion in this appeal, to determine the nature and etiology of the Veteran's sleep apnea. The claims file must be made available to, and reviewed by the examiner. 

Based on a review of the record, examiner must provide an opinion as to whether it is as likely as not (50 percent or better probability) that the Veteran's sleep apnea is due to or aggravated (ie. has progressed at an abnormally high rate due to) by his service-connected major depressive disorder.

If a sleep apnea disability shown is deemed not to be due to or aggravated by the service-connected major depressive disorder, then the examiner should, if possible, identify the cause considered more likely and explain why.

The examiner should thoroughly review and address the December 2003 article submitted by the Veteran that discusses a link between depression and sleep apnea.

The rationale for all opinions expressed must be provided. Another VA examination of the Veteran should only be conducted if deemed necessary by the VA examiner providing the requested medical opinions.

3. Confirm that all medical opinions provided comport with this remand and undertake any other development determined to be warranted. 

4. Then, readjudicate the appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. 

 

 

D. Ware

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Ivan Franklin

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.