Citation Nr: 22017138 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-11 644 DATE: March 24, 2022 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran had active duty service from October 1986 to December 1995. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a Board hearing before the undersigned in October 2021. A transcript of that hearing is of record. The Board regrets further delay, but finds that additional development is necessary before a decision may be rendered regarding the issue on appeal. The Veteran seeks entitlement to service connection for sleep apnea that he contends was present during his active duty service and continues through the present day. Generally, to establish service connection, a Veteran must show: (1) a current disability; (2) an in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). The record contains a current diagnosis of mild obstructive sleep apnea. See December 2014 Private treatment record. However, the RO found that there was not an in-service incurrence of a disease or injury, stating that the Veteran's service treatment records do not contain complaints, treatment, or diagnosis for this condition. The Board finds that the record contains evidence to suggest that an in-service injury or event occurred. The Veteran testified that he was hit in the face with an elbow during a training exercise. After this point, he stated that his fellow soldiers informed him that he was snoring. Although there are no medical records to support, the Board will accept this lay statement of an in-service event. As a medical nexus must be established, a medical opinion is warranted. VA must provide a medical examination when there is evidence of (1) a current disability, (2) an in-service event, injury, or disease, (3) some indication that the claimed disability may be associated with the established event, injury, or disease, and (4) insufficient competent evidence of record for VA to make a decision. McClendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38U.S.C. §5103A (d)(2); 38C.F.R. §3.159(c)(4)(i). The third prong, which requires evidence that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McClendon, 20Vet. App.at 83. The matter is REMANDED for the following action: 1. Obtain an opinion by a suitably qualified health care professional to determine the etiology of the Veteran's obstructive sleep apnea disability. The Veteran may be scheduled for an in-person examination if the clinician deems it necessary to provide the requested opinion. The claims file, to include a copy of this remand, must be made available to the examiner for review, and the examination report should reflect that such a review was accomplished. After review of the claims file, including the Veteran's STRs and lay statements, the examiner should respond to the following: a) The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran's sleep apnea had its onset in, or is otherwise related to, active duty service. The VA examiner is asked to consider the Veteran's lay statements regarding his claimed injury and symptoms of sleep apnea while in service. b) If it is determined that the Veteran's OSA did not have its onset in service, the opinion provider should provide an opinion as to the more likely cause of the Veteran's OSA. A complete rationale must be provided for all opinions offered. If any opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what, if any, additional evidence would potentially allow for a more definitive opinion. The Appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (West 2014). Cynthia M. Bruce Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Nelson, 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.