Citation Nr: 22014683 Decision Date: 03/14/22 Archive Date: 03/14/22 DOCKET NO. 19-18 741A DATE: March 14, 2022 THE ISSUE Entitlement to service connection for sleep apnea. REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active service from April 1982 to January 1987 and from November 1990 to April 1991. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a July 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. In November 2021, the Veteran, along with her husband, testified at a virtual Board hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the Veteran's electronic claims folder. Entitlement to service connection for sleep apnea is remanded. The Veteran contends that she is entitled to service connection for sleep apnea due to her service-connected PTSD. See June 2016 Notice of Disagreement. She also contends that she has had symptoms of sleep apnea since service, although she was not diagnosed with sleep apnea until post-service (2014). See November 2021 Board hearing. The Veteran also indicated that she was a nurse, and that it was her medical opinion that the symptoms she suffered from in and since service were manifestations of sleep apnea. The Veteran submitted private treatment records which record a formal diagnosis of sleep apnea in March 2014. She was afforded a VA sleep apnea examination in May 2019 where the examiner found that the Veteran's sleep apnea was less likely than on related to service because the Veteran was not formally diagnosed until 2014. With regard to the Veteran's contention that her sleep apnea was secondary to or aggravated by her PTSD, the examiner offered a negative opinion's and explained that obstructive sleep apnea was an "independent condition pathologically due to airway restriction, whereas PTSD is due to stressors in this case of service." A negative opinion based solely on the lack of evidence in service treatment records is inadequate. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Board finds the December 2019 VA examiner's opinion regarding direct service connection for the Veteran's sleep apnea to be inadequate for adjudicative purposes. Therefore, the Board finds that a remand is necessary in order to obtain an addendum opinion as to the etiology of the Veteran's diagnosed sleep apnea disability. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate medical professional regarding the etiology of the Veteran's claimed sleep apnea. The Veteran's electronic claims folder, including a copy of this remand, must be provided to the specialist. An examination need not be conducted unless the medical professional finds that one must be performed in order to provide the requested opinion. The examiner is requested to provide an opinion as to the following: Whether it is at least as likely as not that the Veteran's sleep apnea was incurred in or is otherwise related to service, to include as secondary to or aggravated by her service-connected PTSD. The examiner is requested to specifically address the Veteran's and the Veteran's husband's testimony in the November 2021. See also March 2019 correspondence. The examiner is also reminded that the Veteran is a nurse, and that she has opined that the symptoms she experienced in service are now understood to be sleep apnea symptoms. If necessary, the examiner should reconcile his or her opinion with the Veteran's. A complete rationale, with citation to appropriate medical principles, is requested. (Continued on next page.) 2. Thereafter, readjudicate the issue on appeal as noted above. If the determination remains unfavorable to the Veteran, she and her representative should be furnished a supplemental statement of the case (SSOC) which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and her representative should be afforded the applicable time period to respond. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. E. Geary, 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.