Citation Nr: 18160625
Decision Date: 12/28/18	Archive Date: 12/27/18

DOCKET NO. 18-17 891
DATE:	December 28, 2018
REMANDED
Entitlement to service connection for obstructive sleep apnea, to include as secondary to the Veteran’s service-connected psychiatric disability, is remanded.
REASONS FOR REMAND
The Veteran served on a period of active duty for training (ACDUTRA) from June 2006 to August 2006 and had additional periods of ACDUTRA or inactive duty for training (INACDUTRA).  This matter comes before the Board of Veterans’ Appeals (Board) from an April 2017 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA).
Entitlement to service connection for obstructive sleep apnea is remanded.
The Veteran was afforded a VA psychological examination to determine the relationship between his service-connected psychiatric disability and his obstructive sleep apnea in March 2017 and VA obtained an addendum opinion later that month.  The Veteran subsequently submitted an opinion from his treating physician in May 2017 in which she indicated that the Veteran’s obstructive sleep apnea was at least in part due to the weight gain that she suggested was caused by his psychiatric disability.  Unfortunately, this physician did not give any substantial rationale for her opinion and appears to have submitted instead a largely conclusory statement of such a relationship between the Veteran’s weight gain and his psychological symptoms.  
VA obtained an additional medical opinion in August 2017 in which it was again stated that the Veteran’s psychological disability was unrelated to his sleep apnea.  However, although that opinion explicitly indicated that gaining weight is a common cause for obstructive sleep apnea, it failed to comment on the suggestion of the Veteran’s treating physician that his service-connected psychological disability caused him to gain weight and that that weight gain at least in part caused the development of his sleep apnea.  In light of a January 2017 opinion from VA’s General Counsel that obesity may act as an “intermediate step” between a service-connected disability and a disability for which secondary service connection is sought pursuant to 38 C.F.R. § 3.310, the Board finds that it must remand this matter to obtain an adequate opinion regarding whether that or any other service-connected disability caused weight gain and/or obesity that proximately caused the Veteran’s obstructive sleep apnea.  See VAOPGCPREC 1-2017 (Jan. 6, 2017). 
The matter is REMANDED for the following action:
1. Obtain an addendum opinion from an appropriate clinician or clinicians regarding the questions set forth below.  The clinician is asked to specifically consider the history of the Veteran’s weight gain and the contention that that weight gain is due to either the residuals of his hernia surgery or his service-connected psychiatric disability.
(a.) Is it at least as likely as not that the Veteran’s service-connected psychiatric disability has aggravated his obstructive sleep apnea?
(b.) Is it at least as likely as not that the Veteran’s service-connected psychiatric disability caused weight gain that proximately led to the Veteran’s obstructive sleep apnea?
(c.) Is it at least as likely as not that the Veteran’s service connected psychiatric disability caused weight gain that aggravated the Veteran’s obstructive sleep apnea (worsened in severity beyond the natural progression of the disease)?
(d.) Is it at least as likely as not that the residuals of hernia surgery caused weight gain that proximately led to the Veteran’s obstructive sleep apnea?
(e.) Is it at least as likely as not that the residuals of hernia surgery caused weight gain that aggravated the Veteran’s obstructive sleep apnea (worsened in severity beyond the natural progression of the disease)?
 
MATTHEW TENNER
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Whitelaw, Associate Counsel 

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