Citation Nr: 18143390 Decision Date: 10/19/18 Archive Date: 10/18/18 DOCKET NO. 16-07 632 DATE: October 19, 2018 ORDER Entitlement to service connection for sleep apnea to include due to an undiagnosed illness is denied. FINDING OF FACT Sleep apnea was not demonstrated while on active duty, and there is no competent evidence linking the disorder to service to include due to an undiagnosed illness. CONCLUSION OF LAW Sleep apnea was not incurred or aggravated in service. 38 U.S.C. §§ 1110, 1117, 1131; 38 C.F.R. §§ 3.303, 3.317. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 2001 to November 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). To establish entitlement to service-connected compensation benefits, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Service connection may also be established under 38 C.F.R. § 3.317. Under that section, service connection may be warranted for a Persian Gulf veteran who exhibits objective indications of (1) an undiagnosed illness; (2) a medically unexplained chronic multi symptom illness; and (3) a specific illness prescribed under 38 U.S.C. 1117 (d). 38 C.F.R. § 3.317. An undiagnosed illness is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117; 38 C.F.R. § 3.117, unlike those for “direct service connection,” there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). A medically unexplained chronic multi symptom illnesses is one defined by a cluster of signs or symptoms, and specifically includes chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, as well as any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multi-symptom illness. 38 C.F.R. § 3.317 (a)(2)(ii). In this case, the evidence preponderates against finding that the Veteran currently has an undiagnosed illness, a medically unexplained chronic multi symptom illness, or an illness prescribed under 38 U.S.C. 1117 (d), 38 C.F.R. § 3.317. In this regard, the Veteran has been diagnosed with a known disease, i.e., sleep apnea. Hence, unlike an undiagnosed illness, his symptoms have been attributed to a specific diagnosis, and 38 C.F.R. 3.317 is inapplicable. Accordingly, the Board will review the evidence to see if service connection may be awarded pursuant to 38 U.S.C. § 1110. The Veteran contends that his sleep apnea had its onset in service or alternatively that is it related to his exposure to toxic material when he was deployed to the Middle East. In a December 2014 statement, the Veteran reported that he was prescribed many different medications during service to help him sleep. Military personnel records confirm that the Veteran was deployed to Qatar from March to April 2003. In October 2003, the appellant was noted to sleep fitfully, but was often interrupted by cephalgia. In December 2003, while on active duty, the Veteran was evaluated for headache problems. At that time, a sleep study was recommended to determine if a sleep disorder could be contributing to his headaches, but was never completed. In February 2004 the appellant reported having a lack of sleep due to “tons of headaches.” The treating provider recommended that he follow up with psychiatry for treatment of these symptoms. In April 2004, it was noted that the appellant was requesting pain relief to help him sleep. In February 2011, D.M.G., a private neurologist, noted that the appellant was having trouble with his sleep due to headaches. D.M.G. did not diagnose a sleep disorder. In December 2014, the appellant was noted to be claiming a disability pattern related to insomnia. He was noted to be taking medication for insomnia. In March 2015 the appellant was seen in a VA sleep clinic for snoring, fatigue, and reports that his wife had witnessed apneic episodes. The claimant denied narcolepsy. The appellant was provided information on sleep hygiene, and encouraged among other things to lose weight. A subsequent May 2015 VA polysomnogram revealed obstructive sleep apnea. In September 2015, the appellant’s spouse offered a written statement which provided her observations regarding his sleep habits. She discussed his snoring patterns, difficulty using a C-Pap, and that the claimant would sometimes fall asleep in the middle of a conversation. In a December 2015 VA examination report, the examiner noted that the Veteran had risk factors for sleep apnea, and noted the references in the record dating back to the December 2003 exploring possible linkage between sleep complaints and headaches. The examiner noted the 12-year gap in which the Veteran had no complaints regarding sleep problems. The examiner considered all the relevant evidence to include the statement by the Veteran’s wife, and concluded that the current sleep apnea condition was not related to service. Significantly, there is no competent evidence in the record to the contrary. The Board concedes that the Veteran has a current diagnosis of sleep apnea. However, the weight of the most probative medical evidence of record is against finding that the Veteran’s sleep apnea had its onset during service, and no competent medical evidence has connected sleep apnea to any event or injury in service. The Board acknowledges the lay statements from the Veteran’s wife stating that he would have short periods of not breathing while he was asleep dating back to July 2004, and that as he has gotten older, the condition has worsened. While the Veteran, and his wife are competent to report such symptoms, and while the Board accepts that he may have had sleeping problems at that time the medical evidence of record, which is more probative, does not indicate that the Veteran was diagnosed with sleep apnea until 2015. Given the fact that neither the Veteran nor his spouse are trained in the field of medicine their lay statements are not adequate to establish a diagnosis of sleep apnea in service. While the Veteran may sincerely believe that he had sleep apnea in service or that his sleep apnea is related to his sleep problems in service, lay testimony on the etiology of the condition or its diagnosis is less probative than the findings of a trained medical care provider. The Board has considered the Veteran’s claim that his sleep disorder is related to environmental hazards associated with service in the Persian Gulf. Sleep apnea is not, however, an undiagnosed illness and there is no medical evidence of record linking the Veteran’s currently diagnosed condition to service in the Persian Gulf. Additionally, the Veteran received a VA examination in August 2014 in which the examiner opined that all the Veteran’s claimed conditions were diagnosable disorders with clear and specific etiology, and no sleep disorder has been associated by any medical professional to an undiagnosed illness or alleged toxin exposure. The evidence therefore preponderates against entitlement to service connection for sleep apnea. The preponderance of the competent and probative medical evidence shows that the Veteran’s sleep apnea was not was incurred in service and is not related to any event, injury or exposure in service, and the claim must be denied. In reaching this determination, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the appellant’s   claim, the doctrine is not for application. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Allen M. Kerpan, Associate Counsel