Citation Nr: 23048167 Decision Date: 08/31/23 Archive Date: 08/31/23 DOCKET NO. 20-03 899 DATE: August 31, 2023 REMANDED Entitlement to service connection for obstructive sleep apnea (OSA) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from November 1982 to November 2002. This matter comes to the Board of Veterans' Appeals (Board) from a May 2018 rating decision by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran asserts that his OSA onset during active duty, or alternatively, that it is secondary to his service-connected erectile dysfunction (ED). See Jan. 22, 2020 VA Form 9. Medical evidence of record establishes a current diagnosis of OSA. See Dec. 20, 2019 C&P Exam, Sleep Apnea Disability Benefits Questionnaire (DBQ). In December 2019, a VA examiner opined that it was less likely than not that the Veteran's current OSA was related to service, because 14 years passed from the time he discharged and the time of diagnosis, and because his sleep problems during service were due to headaches and shoulder pain. See Dec. 20, 2019 C&P Exam, Medical Opinion DBQ. The Board finds this supporting rationale to be inadequate and remand warranted to obtain an addendum opinion. First, the time at which medical professionals eventually diagnosed a condition is an inadequate basis to support a negative opinion, as there are many reasons why receiving a formal diagnosis may be delayed. Second, the examiner failed to explain how it can be conclusively determined that the Veteran's in-service sleep problems were due to other issues and not OSA. The fact that sleep problems occurred coincident to other issues does not mean the sleep problems were caused by those other issues instead of by OSA. At least, an examiner would need to provide a fuller explanation regarding how it can be determined that in-service sleep problems were due to something other than the claimed disability. Lastly, the Veteran has cited articles and asserted that his OSA may be secondary to his submarine service or service-connected ED, and a medical opinion has not been obtained addressing either point. See Jan. 22, 2020 Form 9. Accordingly, remand is necessary to obtain an addendum opinion addressing the theories raised by the Veteran and the articles cited. Updated VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then obtain a medical opinion addressing the etiology of the Veteran's OSA from a qualified clinician other than the December 2019 examiner. The entire claims file must be made available to and reviewed by the examiner, to include this Remand. A new examination is not needed unless indicated by the examiner. After reviewing the file, the examiner is asked to address whether it is at least as likely as not (close to, but not necessarily, 50 percent probability), that the Veteran's OSA: (a.) is related to or onset during his active duty, to include his service on a submarine involving long-term intermittent exposure to high ambient carbon dioxide, as well as in-service snoring and sleep issues. https://pubmed.ncbi.nlm.nih.gov/14605040/ (last accessed Aug. 29, 2023) (b.) was caused by his ED. In addressing this question, please consider the article submitted by the Veteran noting service-connected ED as a correlate of sleep apnea. https://pubmed.ncbi.nlm.nih.gov/19570042/ (last accessed Aug. 23, 2023) (c.) got worse because of his ED. In addressing this question, please consider the article submitted by the Veteran noting service-connected ED as a correlate of sleep apnea. https://pubmed.ncbi.nlm.nih.gov/19570042/ (last accessed Aug. 23, 2023) In addressing the above, the examiner must review and discuss the articles cited by the Veteran in his January 2020 VA Form 9. The examiner must also consider and discuss the Veteran's lay statements made in the January 2020 VA Form 9, the September 27, 2018 NOD, and the September 27, 2018 Correspondence. If the examiner opines that his in-service sleep problems were due to other issues, the examiner must explain why this is more likely than not the case. A complete rationale for the examiner's opinion should be provided, citing to specific evidence of record, as necessary. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Devin deBruyn, 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.