Citation Nr: 22051157 Decision Date: 09/08/22 Archive Date: 09/08/22 DOCKET NO. 18-28 686A DATE: September 8, 2022 REMANDED The claim of entitlement to service connection for obstructive sleep apnea, claimed as secondary to posttraumatic stress disorder (PTSD), is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1965 to July 1969. The Board notes that in his May 2018 Notice of Disagreement and June 2018 Substantive Appeal, the Veteran appears to be providing argument that his service-connected PTSD is worsening as a result of his sleep apnea. The Board encourages the Veteran to submit a claim seeking an increased rating for PTSD if he believes his condition has worsened. A June 2022 letter from the agency of original jurisdiction provided information to the Veteran on how he could follow up on his concerns. The Board's review in the instant decision, however, is limited to the claim for sleep apnea. Sleep Apnea Though the Board sincerely regrets the delay, the appeal must be remanded for an adequate VA examination before it can be decided. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran asserts that he has sleep apnea that is secondary to his service-connected PTSD. See February 2018 claim. Service connection may be granted on a secondary basis for disability which is proximately due to or the result of service-connected disease or injury, or for additional disability resulting from the aggravation of a nonservice-connected disability by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). An examination with medical opinion was provided in April 2018. While the opinion addresses whether the Veteran's sleep apnea is proximately due to or the result of his service-connected PTSD, it does not address whether the Veteran's sleep apnea is aggravated by his PTSD. As such, this opinion is inadequate and a remand is necessary for an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum opinion regarding the etiology of the Veteran's obstructive sleep apnea from an appropriate clinician. The entire claims file must be made available to and be reviewed by the examiner. The need for another VA examination is left to the discretion of the clinician. . The examiner must provide an opinion regarding whether the Veteran's sleep apnea is at least as likely as not (1) proximately due or the result of service-connected PTSD, or (2) aggravated (any incremental increase regardless of permanence) by service-connected PTSD. A detailed rationale must be provided for all opinions given. The examiner must provide different, separate rationales for causation and aggravation. NOTE: An adequate medical opinion may not be predicated solely on the absence of literature supporting causation or aggravation without discussing those facts specific to this Veteran. J.N. MOATS Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Steve Ginski, 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.