Citation Nr: 22018573 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 18-28 455 DATE: March 29, 2022 REMANDED Entitlement to service connection for obstructive sleep apnea as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 2003 to July 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran presented testimony at a Board hearing before the undersigned Veterans Law Judg. A transcript is on record. Entitlement to service connection for obstructive sleep apnea as secondary to service-connected PTSD is remanded. The matter must be remanded to provide the Veteran an adequate VA examination. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Veteran was provided a VA examination as to whether his obstructive sleep apnea is secondary to his PTSD in October 2017. The examiner noted a diagnosis of obstructive sleep apnea from February 2017. Towards whether the Veteran's obstructive sleep apnea was caused by his PTSD, the examiner opined the conditions are less likely than not related, rationalizing the claimed disorder is separate entirely from his service-connected condition and that medically literature does not support a medical relationship. The examiner did not provide any findings, rationales, or opinions towards whether the Veteran's obstructive sleep apnea has been aggravated by his PTSD. As secondary service connection opinions require separate findings and rationales for causation and aggravation and the October 2017 VA opinion is lacking in this regard, a remand is necessary to provide the Veteran with an adequate VA examination investigating the potential link between his obstructive sleep apnea and PTSD. Atencio v. O'Rourke, 30 Vet. App. 74, 90 (2018); Id. Moreover, the Board notes the October 2017 VA examiner rationalized that medical literature does not support a medical relationship between obstructive sleep apnea and PTSD. However, later in October 2017, the Veteran submitted a medical article indicating an increased incidence of obstructive sleep apnea in Veterans Health Administration beneficiaries with psychiatric disorders such as PTSD. As such, a VA examiner should address this evidence while rendering an opinion on whether the Veteran's PTSD caused his obstructive sleep apnea. The Veteran is advised he too may provide medical evidence of a link between these two conditions, as was proposed at his November 2021 Board hearing. The matter is REMANDED for the following actions: 1. Schedule the Veteran for a VA examination on the nature and etiology of his obstructive sleep apnea and its relation to the Veteran's service-connected PTSD. The electronic claims file and a copy of this remand must be made available for review. Following review of the claims file, the examiner must opine on whether the Veteran's obstructive sleep apnea is at least as likely as not (approximately 50 percent probability or greater) either (a) proximately due to or (b) aggravated by his service-connected PTSD. In rendering these opinions, the examiner is asked to comment on the article submitted by the Veteran in October 2017 indicating an increased incidence of obstructive sleep apnea in Veterans Health Administration beneficiaries with psychiatric disorders such as PTSD. Aggravation does not require that there be "permanent" worsening of the nonservice connected disability. The examiner must provide separate findings and rationales relating to causation and aggravation. A complete rationale with clear conclusions, supporting data, and a reasoned medical explanation connecting the two must be provided for any opinion. 2. Readjudicate the claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.A. Infante, 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.