Citation Nr: 18141395 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 16-32 988 DATE: October 10, 2018 ORDER Service connection for obstructive sleep apnea is granted. FINDING OF FACT It is at least as likely as not that the Veteran’s obstructive sleep apnea is secondary to his service-connected posttraumatic stress disorder (PTSD). CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for an award of service connection for obstructive sleep apnea have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from November 1965 to September 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office in Chicago, Illinois. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Under applicable law, disability which is proximately due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995). Whenever there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the Veteran. 38 U.S.C. § 5107(b). Entitlement to service connection for obstructive sleep apnea as secondary to service-connected PTSD. The Veteran contends that his obstructive sleep apnea has been caused and/or aggravated by his service-connected PTSD. See, e.g., August 2013 Claim. His service-connected PTSD is currently rated as 70 percent disabling. See December 2013 Rating Decision Codesheet. During a May 2012 VA sleep study, he was diagnosed with severe obstructive sleep apnea. The claims file contains conflicting medical opinions with respect to whether the Veteran’s sleep apnea has been caused or aggravated by PTSD. The Veteran submitted a July 2013 letter from a private physician who is board certified in both sleep disorder medicine and psychiatry, and has conducted over 35 research studies on sleep apnea, PTSD, and other associated sleep disorders. The physician noted that “scientific literature is clear that there is an association that is much greater than expected between sleep apnea and PTSD.” After reviewing the Veteran’s VA records, the physician opined that the Veteran’s obstructive sleep apnea is secondary to his PTSD. An October 2013 VA examiner reviewed the claims file and determined that sleep apnea was less likely than not proximately due to or a result of PTSD. The examiner opined that the Veteran’s sleep apnea was the result of an “uvulopalatal anatomic abnormality.” In an October 2013 addendum, the examiner reviewed the July 2013 private physician’s letter. The examiner opined that PTSD is a mental condition and sleep apnea is a mechanical condition and that the examiner was “not aware of any credible scientific literature that clearly concludes that “PTSD causes PTSD (sic).” The Board finds the evidence to be at least in relative equipoise as to whether the Veteran’s sleep apnea has been caused or aggravated by his PTSD. The private physician who wrote the July 2013 letter appears to be well-qualified in this area. He reviewed the Veteran’s VA records and relied on scientific literature to determine that there is a greater than expected association between PTSD and sleep apnea; ultimately concluding the Veteran’s sleep apnea was secondary to his PTSD. In the Board’s view, the private physician’s opinion is no less probative than that obtained from the VA examiner, who did not address whether PTSD aggravated the Veteran’s sleep apnea. Resolving reasonable doubt in the Veteran’s favor, the criteria for an award of service connection for obstructive sleep apnea have been met. The evidence, at a minimum, give rise to a reasonable doubt on the matter. 38 C.F.R. § 3.102. The appeal is granted. DAVID A. BRENNINGMEYER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Howell, Associate Counsel