Citation Nr: 22045294 Decision Date: 08/10/22 Archive Date: 08/10/22 DOCKET NO. 19-35 749 DATE: August 10, 2022 REMANDED Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran had active duty service from November 1985 to November 1989. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is remanded. Review of the record reveals that remand is required in order to retrieve any medical treatment records and to arrange for an addendum opinion. Initially, the Board notes that the Veteran's service records are mostly silent for any complaints of or treatment for a sleep disorder. The Veteran has submitted a statement from one of his fellow soldiers who claims that the Veteran had severe snoring problems during service and had to stay up some nights for the sake of noise discipline. The Veteran received a VA examination in March 2019, wherein he was diagnosed with obstructive sleep apnea, dated 2012. The examiner reported that the Veteran sometimes uses a CPAP machine to help him sleep. The examiner determined that the Veteran's obstructive sleep apnea is not attributable to his service-connected PTSD. Instead, the examiner reasoned that the Veteran's obesity was the primary cause of the sleep apnea and stated that medical literature does not list PTSD as a risk factor for developing a condition such as sleep apnea. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Considering the above, the Board finds the March 2019 VA examination report to be inadequate for rating purposes due to limited rationale and conflicting information. Importantly, the examiner did not address the statements claiming that the Veteran's snoring and sleep problems onset during service, and an opinion as to direct service connection was not provided. Given the Veteran's statements and the inadequate VA opinion that did not properly consider each theory of service connection, the Board finds that an addendum opinion is warranted. Finally, there may be outstanding or pertinent treatment records available for review. The Board finds that it would be prudent for an attempt to obtain any outstanding treatment records be made. The matters are REMANDED for the following action: 1. With the assistance of the Veteran as necessary, identify and obtain any outstanding, relevant treatment records, and associate them with the Veteran's electronic claims file. If the Agency of Original Jurisdiction (AOJ) cannot locate or obtain such records, it must specifically document the attempts that were made to locate or obtain them and explain in writing why further attempts to locate or obtain any government records would be futile. The AOJ must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. All attempts to obtain records should be documented in the Veteran's electronic claims file. 2. Then, obtain an addendum opinion from an examiner of appropriate expertise to determine the nature and etiology of the Veteran's claimed obstructive sleep apnea, to include as secondary to service-connected PTSD. The electronic claims files and all pertinent records must be made available to the examiner and the examiner must indicate in the examination report that these records have been reviewed. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (a) The VA examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that obstructive sleep apnea manifested in-service or is otherwise causally or etiologically related to the Veteran's military service. (b) If not directly related to service, the examiner should offer an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his obstructive sleep apnea is caused by his service-connected PTSD. (c) That examiner should then opine whether the obstructive sleep apnea is aggravated by his service-connected PTSD. In offering any opinion, the examiner must consider the full record, to include the lay statements in support of the Veteran's claim which indicate his snoring onset during service. The examiner should also reconcile any prior report, as necessary. The rationale for any opinions offered should be provided. If the VA examiner determines that further examination is necessary in order to render the requested medical opinion, then the Veteran should be scheduled for such an examination. 3. After the development requested has been completed, the AOJ should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. Mike Sobiecki Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Miller, 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.