Citation Nr: 22017550 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 17-57 957 DATE: March 25, 2022 REMANDED Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1984 to October 1984, from September 1992 to December 1992, and in October 2001. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled to testify at a Board hearing in October 2021 but did not show. He has not provided good cause for not showing or requested another hearing. Accordingly, the Board considers his November 2017 hearing request to be withdrawn. 38 C.F.R. § 20.704(d). In this case, the Veteran asserts that his sleep apnea and related symptoms had an onset in service or are otherwise related to his service. Multiple post-service medical records indicate that the Veteran has a current diagnosis of obstructive sleep apnea, a history of snoring, and uses a bi-level positive airway pressure (BiPAP) device for treatment. In addition, service treatment records (STRs) show the Veteran complained of "constant fatigue" in his November 2001 post-deployment health questionnaire, as well as headaches and fatigue in a June 2001 pre-deployment health questionnaire. The Veteran also submitted a statement in December 2015 regarding the onset of his sleep apnea and symptoms such as tiredness and fatigue experienced in service. Moreover, the Veteran contends that his sleep apnea and related symptoms began after his deployment to Southwest Asia. As such, the Board finds that a VA opinion is needed as the evidence of record does not provide sufficient information to adequately address 38 C.F.R. § 3.317 regarding a chronic disability due to undiagnosed illness or a medically unexplained chronic multi-symptom illness (MUCMI), or otherwise present medical findings in a manner that permits the Board to make the requisite determinations under 38 C.F.R. § 3.317. See Stewart v. Wilkie, 30 Vet. App. 383 (2018) (clarifying that under 38 C.F.R. § 3.317, an illness is a MUCMI where either etiology or pathophysiology of the illness is inconclusive). Based on the foregoing, the Board finds that a VA examination and opinion is warranted in order to determine whether the Veteran's reported symptoms in service were manifestations of his current sleep apnea and/or sleep problems and to address 38 C.F.R. § 3.317. As such, the Board finds that the low threshold for requiring a VA examination under the duty to assist have been met, and a VA examination is warranted for the issue noted above. McClendon v. Nicholson, 20 Vet. App. 79 (2006); 38 C.F.R. § 3.159(c)(4). This matter is REMANDED for the following action: Schedule the Veteran for an examination with an appropriate clinician (or clinicians, if necessary) to determine whether any current sleep-related disorder or symptoms thereof are related to the Veteran's active service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. For each sleep-related disability shown upon examination, the examiner should opine whether it is at least as likely as not (at least an approximate balance of positive and negative evidence) that the disorder began in or is otherwise related to the Veteran's active service. The examiner should address the Veteran's lay statements regarding symptoms and any other pertinent evidence of record, including the documented reports of fatigue sleep-related problems in service after deployment. The examiner should also address whether the Veteran's sleep apnea and related symptoms are attributable to a known clinical diagnosis. If the symptoms are attributable to a known clinical diagnosis, the examiner must then discuss both the etiology and pathophysiology of the condition to which the reported symptoms have been attributed with emphasis on whether both the etiology and pathophysiology of the condition are understood or at least partially understood in the context of his unique circumstances. If any of the claimed symptoms are attributable to a known clinical diagnosis with both an etiology and pathophysiology that are at least partially understood in the context of the Veteran's unique circumstances, the examiner must then address whether the condition is at least as likely as not (at least an approximate balance of positive and negative evidence) the result of disease or injury in active service, to include exposure to hazards while serving in the Gulf War. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Ariasaif, Mary 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.