Citation Nr: 21055584 Decision Date: 09/08/21 Archive Date: 09/08/21 DOCKET NO. 17-59 208 DATE: September 8, 2021 REMAND Entitlement to service connection for sleep apnea is remanded. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from July 1952 to March 1954. This matter comes before the Board of Veterans' Appeals (Board) on appeal from June 2017 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). This case has a lengthy procedural history which the Board will summarily review. In March 2018, the Board remanded the claim for further development. After said development, the Board denied the claim in an August 2019 decision. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In July 2020, the Court granted the parties' joint motion for remand. Pursuant to the joint motion, the Board remanded the claim in February 2021 and May 2021. As a final initial matter, an October 2019 rating decision found the Veteran was not competent to handle disbursement of funds. The record, including as indicated in the Veterans Benefits Management System, reflects the Agency of Original Jurisdiction has appointed C. E. as a fiduciary. Thus, the Board has also listed C. E. on the title page as a fiduciary. Entitlement to service connection for sleep apnea is remanded. The Veteran provides several theories as to why his sleep apnea is related to service. Namely, he alleges that it is directly related to service, is secondary to any of his service-connected disabilities, to include medications he takes for them, or is the result of the obesity that he alleges he developed as a result of his service-connected disabilities. Pursuant to the May 2021 Board remand, a May 2021 VA addendum medical opinion was obtained. The examiner was directed to (a) list all medications prescribed throughout the period on appeal and label whether these medications are prescribed for any service-connected disability, (b) determine whether any effects of medications used for service-connected disabilities could cause or aggravate the Veteran's sleep apnea, and (c) discuss whether the Veteran's service-connected disabilities caused him to become obese, whether said obesity was a substantial factor in causing sleep apnea, and whether the sleep apnea would have occurred but for the obesity. The May 2021 VA examiner noted these medications as related to service-connected disabilities: calcium, vitamin D, lidocaine, memantine, menthol, mirtazapine, multivitamin, paroxetine, carboxymethylcellulose, trazodone, vitamin B, vitamin C, aripiprazole, clonazepam, galantamine, and sertraline. The examiner additionally noted these medications as unrelated to service-connected disabilities: oxycodone, latanoprost, and dorzolamide. Unfortunately, remand is necessary to comply with the May 2021 remand directives. Here, even a cursory review of the Veteran's claim file reveals he has been prescribed more medications than just those listed by the May 2021 VA examiner during the appeal period. As the June 2020 joint motion identified, the Veteran was taking at least 24 medications; the VA examiner's list falls well short of that number. For example, as of March 2021, the Veteran was currently prescribed: alendronate, calcium, cetirizine, cholecalcif, clopidogrel, ezetimibe, finasteride, fish oil, gabapentin, hyaluronate, hydrophilic, lidocaine, lisinopril, memantine, menthol, metformin, metoprolol tartrate, mirtazapine, multivitamin, glucerna shake, olopatadine, pantoprazole, peg 400, rosuvastatin, sunscreen, timolol, tobramycin, vitamin B, and asprin. This is a non-exhaustive list. Because the May 2021 VA medical opinion did not identify a complete list of medications throughout the appeal period, it is unclear as to whether the examiner considered all the relevant medications. Stegall v. West, 11 Vet. App. 268 (1998). To further illustrate this, newly obtained September 2015 VA treatment records show that the Veteran was prescribed buspirone to treat his service-connected anxiety, but buspirone was not considered by the May 2021 examiner. Given this development, another remand is warranted to obtain an addendum VA nexus opinion on the service-connected medication theory question only. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA and private treatment records. 2. Obtain an addendum opinion from an appropriate clinician, different from the one who provided the May 2021 medical opinion, regarding the nature and etiology of the Veteran's sleep apnea. The clinician is asked to provide a response to the following: (a) List ALL medications prescribed for service-connected disabilities before the diagnosis of sleep apnea AND throughout the period on appeal (from April 13, 2017), regardless of whether or not they are currently prescribed or were used to treat service-connected disabilities. In other words, the examiner must comb through the claims file and list: a. Any medication specifically used to treat a service-connected condition before April 13, 2017, and b. Any medication prescribed after April 13, 2017 regardless of its use. (b) Then, the examiner must label each medication listed as to whether or not it is (or was) prescribed for any of the Veteran's service-connected disabilities. If yes, which disability? (c) Then, for any medication prescribed to treat a service-connected disability, the examiner must determine whether it is at least as likely as not that the prescribed medication or any of its effects caused or aggravated the Veteran's sleep apnea. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, 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.