Citation Nr: 18160703
Decision Date: 12/27/18	Archive Date: 12/27/18

DOCKET NO. 16-63 601
DATE:	December 27, 2018
Entitlement to service connection for obstructive sleep apnea, as due to service-connected post-traumatic stress disorder (PTSD) is remanded.
Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded.  
The Veteran served on active duty from June 1987 to August 1987, from January 1989 to January 1993, from January 1998 to June 1998, from July 2003 to November 2003, from January 2008 to April 2008, and from May 2008 to July 2008.
A remand is necessary to determine whether the Veteran’s sleep apnea is related to his service-connected disabilities – particularly, his obstructive sleep apnea.
The Veteran seeks service connection for obstructive sleep apnea.  While the Veteran has a current diagnosis of this disorder, his service records do not mention sleep apnea, nor does the evidence reflect continuous symptomatology since service.  Moreover, the medical evidence does not indicate a direct nexus.  See 38 C.F.R. § 3.303(a); McLendon v. Nicholson, 20 Vet. App. 79 (2006).  However, the sleep study report dated August 2015 suggests that the Veteran’s reduced sleep efficiency “could be secondary to sleeping in a laboratory environment, medications, or mood disorders.”  Therefore a remand is warranted because further examination is likely to shed light on whether the Veteran’s severe PTSD caused or aggravated his obstructive sleep apnea.   
The Veteran’s TDIU claim is intertwined with the above remanded claim, and therefore it is also remanded at this time.  See Henderson v. West, 12 Vet. App. 11, 20 (1998); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).
The matter is REMANDED for the following action:
1. Obtain any and all VA treatment records not already associated with the claims file from the San Diego VA Medical Center, or any other VA medical facility that may have treated the Veteran and associate those documents with the claims file.
2. Ensure that the Veteran is scheduled for a VA examination with an examiner who has not previously participated in this case in order to determine whether his obstructive sleep apnea related to service or secondary to his service-connected psychiatric disability.  The claims folder must be made available to and be reviewed by the examiner.  All tests deemed necessary should be conducted and the results reported in detail.  
Following examination of the Veteran and review of the claims file, the examiner must opine whether the Veteran’s obstructive sleep apnea at least as likely as not (50 percent or greater probability) began in or is otherwise related to his miliary service.  
Next, if the examiner does not find that the Veteran’s obstructive sleep apnea is directly related to military service, the examiner must opine whether his obstructive sleep apnea at least as likely as not are (a) caused by; or, (b) aggravated (i.e., chronically worsened) by the Veteran’s service-connected psychiatric disability.  The examiner should specifically discuss the August 2015 sleep study examiner’s report respecting the above requested opinions.  The examiner is reminded that he or she must address both prongs (a) and (b) above.
In addressing the above, the examiner should consider any of the Veteran’s lay statements regarding symptomatology during service and any continuity of symptomatology since discharge and/or since onset.  The examiner should also consider any other pertinent evidence of record, as appropriate.  All findings should be reported in detail and all opinions must be accompanied by a clear rationale.
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Z. Maskatia, Associate Counsel

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