Citation Nr: 22017170 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-07 714 DATE: March 24, 2022 REMANDED Entitlement to service connection for sleep apnea, to include as due to posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served active duty in the United States Army from November 1967 to October 1969. In April 2018, January 2021, and July 2021, the Board remanded the appeal for further development. 1. Service connection for sleep apnea is remanded. The Veteran contends that his sleep apnea is due to his period of service, to include as due to his service-connected PTSD. In a January 2021 VA mental health examination, the examiner noted sleep apnea as a medical diagnosis relevant to understanding or managing the Veteran's mental health disorder. The examiner indicated "defer to physician" regarding the ICD code. In a March 2021 VA medical opinion, the examiner explained that although there is literature stating that PTSD can aggravate obstructive sleep apnea, there is no medical literature found that shows PTSD as the direct and sole cause of obstructive sleep apnea. The Board notes that the examiner did not address whether the PTSD, in the case of this Veteran, aggravated the Veteran's obstructive sleep apnea. In a November 2021 VA addendum opinion, the examiner opined that it is less likely than not that the Veteran's obstructive sleep apnea is aggravated beyond natural progression by his service-connected PTSD. The examiner explained the characteristics and risk factors for the etiology of sleep apnea. The examiner noted that the Veteran currently reports he is not taking any medications for his PTSD or Depression and is not currently in any therapy. The examiner also stated that the Veteran reports he was prescribed melatonin to assist with sleeping more at night, but he stopped taking it. The examiner further stated that the Veteran reports he sleeps in a separate room from his current wife because of the noise with the CPAP machine. The examiner concluded that due to lack of evidence regarding treatment for PTSD and symptoms, he was unable to establish a connection with the Veteran's obstructive sleep disorder and if it is exacerbated by his diagnosis of PTSD with unspecified depression. The Board notes that the November 2021 addendum opinion does not indicate consideration of the Veteran's mental health records of file, to include the January 2021 VA mental health examination. Moreover, the record contains conflicting evidence regarding aggravation which the November 2021 opinion did not reconcile. Therefore, a remand for an addendum opinion is necessary. The matters are REMANDED for the following action: 1. Send the Veteran's file to an appropriate examiner to determine the nature and etiology of the Veteran's obstructive sleep apnea. Schedule an examination only if the examiner deems it necessary. The claims file, to include this remand, should be made available and reviewed by the examiner. After review of the record, the examiner is asked to offer an opinion on the following: Determine whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's obstructive sleep apnea is aggravated by the Veteran's service-connected PTSD. In making this determination, the examiner must consider and discuss the January 2021 VA PTSD examination and reconcile the March 2021 VA medical opinion noting that PTSD can aggravate obstructive sleep apnea. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Ford 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.