Citation Nr: 22034883 Decision Date: 06/15/22 Archive Date: 06/15/22 DOCKET NO. 17-20 132 DATE: June 15, 2022 REMANDED Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 2001 to November 2007, including service in Iraq from October 2005 to September 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in his April 2017 VA Form 9, the Veteran requested a hearing before a Veterans Law Judge which was scheduled in August 2021. However, the hearing notice was returned as undeliverable. After updating the Veteran's address, a second hearing notice was mailed to the Veteran in February 2022 which was also returned as undeliverable. Thus, the Veteran did not appear for his hearing scheduled in May 2022. A search by VA showed that the Veteran's current address is the same as noted in VA's system. In this regard, the Board notes that it is ultimately the responsibility of the Veteran to notify VA of any changes of address or contact information. See Hyson v. Brown, 5 Vet. App. 262, 265 (1993) (holding that "[i]n the normal course of events, it is the burden of the Veteran to keep VA apprised of his whereabouts"). Thus, the Board finds that VA satisfied the duty to notify the Veteran when it mailed the hearing notification letters to the most current address of record. Accordingly, his hearing request is deemed withdrawn. 38 C.F.R. §§ 20.603(d), 20.704(d). With regard to the merits of the Veteran's claim, the Board finds a remand is warranted before the Board can properly adjudicate the claim. The Board notes that the Veteran received a sleep apnea Disability Benefits Questionnaire (DBQ) in January 2017. In the examination, the examiner found that the Veteran was diagnosed with sleep apnea in 2011, but that it had resolved in 2016. Additionally, in a January 2017 Gulf War examination, the same examiner noted that the Veteran had a history of sleep apnea and concluded that it was a biomechanical condition and has no nexus to service in the Persian Gulf or exposure to any environmental hazards while serving in the Persian Gulf. The examiner explained that sleep apnea is a condition in which loose, floppy tissues in the throat occlude the passage of air during the relaxation of sleep. Thus, the examiner concluded it was not an unexplained chronic multi-symptom illness but has a specific pathophysiology. Conversely, in a January 2017 medical opinion, a VA psychiatrist noted that the Veteran is a patient in the PTSD outpatient clinic at the VA system in Seattle, Washington where he is currently being treated. The psychiatrist also noted that the Veteran was diagnosed with sleep apnea in 2012. Further, the psychiatrist indicated that medical literature reflects that if left untreated, sleep apnea could exacerbate a number of psychiatric and medical conditions, including PTSD. Despite the opinions of record, the Board finds the opinions are inadequate for adjudicating the Veteran's claim. First, the Board notes that while the examiner in the Veteran's January 2017 sleep apnea DBQ found that the Veteran's sleep apnea had resolved, this is contrary to VA treatment records which shows the Veteran was given a polysomnogram in June 2016 and was diagnosed with mild obstructive sleep apnea. Next, although the January 2017 VA psychiatrist indicated that sleep apnea could exacerbate the Veteran's service-connected PTSD, this is not the relevant question before the Board. Rather, the question before the Board is whether the Veteran's PTSD caused or aggravated the Veteran's sleep apnea. Therefore, remand is necessary to obtain a new examination and medical opinion to determine the etiology of the Veteran's sleep apnea. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Schedule a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of the Veteran's sleep apnea. All indicated tests and studies should be conducted, and all findings reported in detail. The examiner should then opine as to whether it is at least as likely as not: (a) The Veteran's sleep apnea had its onset in service, or is otherwise related to service, to include as due to environmental exposure during service in Southwest Asia during the Persian Gulf War; or, (b) The Veteran's sleep apnea is proximately due to his service-connected PTSD; or, (c) The Veteran's sleep apnea has been aggravated by his service-connected PTSD. Please note that separate opinions addressing proximate cause and aggravation are needed. It is not necessary that PTSD be service-connected, or even diagnosed, at the time his sleep apnea was incurred, and reliance on this fact in support of a negative opinion will render it inadequate. A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. Jarrette A. Marley Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Laffitte, 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.