Citation Nr: 22016303 Decision Date: 03/21/22 Archive Date: 03/21/22 DOCKET NO. 19-24 349 DATE: March 21, 2022 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1989 to February 1993, July 2004 to April 2005, and July 2007 to August 2008. He also had additional years of inactive service. This matter comes before the Board of Veterans' Appeals (Board) from an August 2017 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge during an October 2021 hearing and a transcript is of record. The appeal is remanded for the following development. VA examination and medical opinions: The RO must obtain a VA examination and medical opinion to address the etiology of the Veteran's OSA, including whether his OSA is secondary to his service-connected PTSD. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). See October 2021 private medical opinion (opining that the Veteran's service-connected posttraumatic stress disorder (PTSD) is a major factor in precipitating and causing his OSA). (The Board finds that this conclusory private medical opinion is inadequate to adjudicate the claim because it did not include a rationale.) Service personnel records: The Veteran contends that his OSA began when he was serving in Operation Desert Storm. See November 2016 statement. He also contends that his OSA is due to toxic environmental exposures during his first active-duty period, when he reportedly served near Kuwait's oil fields. See October 2021 hearing transcript. His DD Forms 214 note his receipt of the Kuwait Liberation Medal and the Southwest Asia Service Medal with three bronze stars (among other awards and medals). Moreover, service treatment records reference his Operation Desert Storm deployment. However, the specific dates and locations of that deployment are unverified because the RO did not obtain his complete service personnel records from his first period of active service. The RO must attempt to do so because this information goes to whether the Veteran was presumptively exposed to fine, particulate matter based on a "qualifying period of service" under 38 C.F.R. § 3.320(a)(3) and (a)(4). VA treatment records: The Veteran's representative asserted that the Veteran has received VA medical care since 1993. See October 2021 hearing transcript. However, the earliest VA outpatient treatment records that the RO obtained are from mid-2002. The RO must obtain all outstanding VA outpatient treatment records from 1993 to mid-2002, and specifically ask the facility to search archived or retired paper treatment records. Private treatment records: The record shows that the Veteran sees a private primary care provider. Although he submitted some private treatment records from this provider, they appear to be incomplete. The RO should attempt to obtain authorization and request all outstanding medical records from this provider. Buddy statements: In a November 2016 statement accompanying his claim application, the Veteran stated that his OSA began when he was serving in Operation Desert Storm. He stated, "People have told me that I stop breathing while sleeping and often wake up short of breath..." Since the Board must remand for the reasons discussed above, the RO should invite the Veteran to submit lay statements by anyone who can testify to his OSA symptoms during and continuing since his first period of active service. The matters are REMANDED for the following action: 1. Send the Veteran and his representative a letter inviting them to submit buddy statements / lay statements by people who can testify to the Veteran's OSA symptoms during and continuing since his first period of active service. 2. Request the Veteran's complete service personnel records from his first period of active service, March 1989 to February 1993. Document all attempts to obtain them and any negative responses. If any records are unavailable and further requests to obtain them would be futile, prepare the appropriate memorandum for the file. 3. Obtain the Veteran's VA outpatient treatment records from the Leavenworth VAMC and all associated outpatient clinics from January 1993 through August 2002. The RO specifically must ask the facility to search archived or retired paper treatment records. Merely documenting a lack of electronic treatment records in (e.g., in CAPRI / CPRS or Vista) will not comply with this instruction. Document all requests and any negative responses. 4. After obtaining completed releases from the Veteran, request all medical records from Leavenworth Lansing Family Health Center (including Dr. P.C.) and any other identified private / non-VA providers. Document all attempts to obtain the records and any negative responses. If any requested records are unavailable, then notify the Veteran and his representative. 5. DO NOT SCHEDULE THE FOLLOWING until completing the instructions above and obtaining as many records as possible. 6. Then, schedule a VA examination to assess the etiology of the Veteran's current OSA. The examiner must answer the following, with full rationales: Is the evidence in approximate balance that his current OSA was incurred in or is otherwise related to active service? The Veteran contends that his OSA began during his Operation Desert Storm deployment (during his first period of active service). See November 2016 statement. He also contends that his OSA is due to toxic environmental exposures during that period, when he reportedly served near Kuwait's oil fields. See October 2021 hearing transcript. Is the evidence in approximate balance that his current OSA was caused by (proximately due to) his service-connected PTSD? Please expressly consider: October 2021 private medical opinion (opining that the Veteran's service-connected PTSD is a major factor in precipitating and causing his OSA); July 2021, October 2020, August 2017 VA PTSD examinations (noting PTSD symptoms included sleep disturbance and chronic sleep impairment). Is the evidence in approximate balance that any current OSA is aggravated (worsened to any degree) by his service-connected PTSD? Please expressly consider: October 2021 private medical opinion (opining that the Veteran's service-connected PTSD is a major factor in precipitating and causing his OSA); July 2021, October 2020, August 2017 VA PTSD examinations (noting PTSD symptoms included sleep disturbance and chronic sleep impairment). The examiner must note his or her review of the complete claims file, including this remand. If any requested opinion is not possible without speculation, then the examiner must explain why. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Janofsky, 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.