Citation Nr: 18139642
Decision Date: 09/28/18	Archive Date: 09/28/18

DOCKET NO. 16-15 700A
DATE:	September 28, 2018
REMANDED
Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected asthma is remanded.
REASONS FOR REMAND
The Veteran served on active duty from August 2000 to August 2004. 
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio.
In August 2017, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge via videoconference. A transcript is included in the claims file.
Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected asthma is remanded.
The Veteran was afforded a VA examination to determine the nature and etiology of his obstructive sleep apnea in September 2011. The examiner opined that the Veteran’s obstructive sleep apnea was less likely as not caused by or the result of his service-connected asthma. However, the examiner did not opine as to whether the Veteran’s obstructive sleep apnea was directly related to his active service or whether his obstructive sleep apnea was aggravated by his service-connected asthma. During the August 2017 Board Hearing, the Veteran testified that he experienced symptoms of daily fatigue, headaches, and what he interpreted as nighttime asthma attacks in service. A November 2003 service treatment record reflects that he reported nightly paroxysmal nocturnal dyspnea. Further, the September 2011 VA examiner indicated that “the exact interaction between asthma and sleep apnea is unclear, although it seems that the two conditions can aggravate each other.”
Accordingly, a remand is necessary for an addendum opinion to clarify the etiology of the Veteran’s obstructive sleep apnea. 
The matter is REMANDED for the following action:
1. Ask the Veteran to identify any private or VA treatment records that are not associated with the claims file pertaining to the Veteran’s obstructive sleep apnea. Attempt to obtain any identified records.
2. Obtain an addendum medical opinion from an appropriate medical provider to determine the nature, onset, and etiology of the Veteran’s obstructive sleep apnea.
(a.) Whether it is at least as likely as not that the Veteran’s obstructive sleep apnea had its onset in service or is otherwise etiologically related to service.
(b.) If the answer to the above is in the negative, provide an opinion on whether it is at least as likely as not that the Veteran’s obstructive sleep apnea was caused OR aggravated by his service-connected asthma. 
The examiner should provide a complete rationale for the opinion (for both causation AND aggravation), whether favorable or unfavorable, and cite to specific evidence of the record, as necessary.
In rendering these opinions, the evaluator should consider the Veteran’s contention that he had symptoms of sleep apnea in service, as well as the April 2016 letter from Dr. Reichert noting that “having asthma greatly increases the likelihood of concomitant sleep apnea.” The evaluator should also review the April 2003 service treatment record noting the Veteran reported still feeling tired after sleeping, and the November 2003 service treatment record noting nightly paroxysmal nocturnal dyspnea.

 
Cynthia M. Bruce
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	E. Duthely, Associate Counsel

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