Citation Nr: 22017104
Decision Date: 03/24/22	Archive Date: 03/24/22

DOCKET NO. 15-15 874
DATE: March 24, 2022

REMANDED

Entitlement to service connection for a sleep disorder, to include as secondary to service-connected disabilities is remanded.

REASONS FOR REMAND

The Veteran had active service in the United States Air Force from December 1989 to July 1993 and in the United States Navy from April 2003 to December 2003 and from December 2006 to December 2007.  This matter is on appeal from an April 2012 rating decision.  In August 2018, the Veteran testified before the undersigned.  A copy of the transcript is associated with the record.  In March 2019, March 2021, and October 2021, the Board remanded the appeal for additional evidentiary development.

Entitlement to service connection for a sleep disorder, to include as secondary to service-connected disabilities is remanded.

While the Board sincerely regrets further delay in this matter, additional development is required before the Veteran's claim may be adjudicated on the merits.  In October 2021, the Board remanded the appeal to obtain an opinion that addresses the etiological relationship between the Veteran's service-connected posttraumatic stress disorder (PTSD) and his obstructive sleep apnea.  The VA examiner was asked to address the medical literature cited in the August 2021 brief.

In November 2021, VA obtained the requested opinion.  The VA examiner opined that the Veteran's sleep apnea was less likely than not proximately due to or the result of his PTSD.  The rationale was that the studies link a great association between obstructive sleep apnea and PTSD, but do not show causation.  Sleep apnea was more likely due to the Veteran's weight and secondary factors.   The VA examiner opined that the Veteran's obstructive sleep apnea was less likely than not aggravated by his service-connected PTSD.  He explained that the Veteran's condition had improved with the use of CPAP.  The VA examiner concluded that PTSD may be causing nightmares and insomnia but was not related to obstructive sleep apnea.  The Board finds that these opinions are conclusory and are not supported by sufficient rationale.  The VA examiner asserted that the studies were associative rather than causative but did not provide a rationale for this assertion.

Finally, in February 2022, the Veteran's representative asserted that the Veteran's obstructive sleep apnea is caused by the medication he takes to treat his PTSD.  Additionally, the Veteran's representative cited additional studies regarding the relationship between PTSD and obstructive sleep apnea.  A remand is required to obtain an adequate opinion that addresses the etiological relationship between the Veteran's PTSD and his obstructive sleep apnea.  

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's obstructive sleep apnea is at least as likely as not proximately due to or aggravated by the service-connected PTSD, to include the medication taken to treat PTSD.  In rendering the opinion, the VA examiner is asked to address the medical literature cited in the August 2021 and February 2022 briefs. 

2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal.  If the benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond.  If necessary, return the case to the Board for further appellate review.

 

 

DAVID L. WIGHT

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R.R. Watkins, 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.