Citation Nr: 18143645 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 16-32 967 DATE: October 19, 2018 ORDER Entitlement to service connection for obstructive sleep apnea, to include as secondary to exposure to environmental hazards, is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his obstructive sleep apnea manifested in service. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea are met. 38 U.S.C. §§ 1110, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from March 1979 to March 1982; January 1986 to May 1986; January 1991 to June 1991; and November 2000 to November 2003. During his periods of service, the Veteran earned the Army Service Ribbon, Army Lapel Button, National Defense Service Medal, Expert Badge (Pistol), Expert Badge (M-16 Rifle), Marksman Badge (Hand Grenade), Meritorious Service Medal, Army Commendation Medal, Army Achievement Medal (3rd Award), Southwest Asia Service Medal with 2 Bronze Service Stars, Noncommissioned Officer’s Training Ribbon, and Kuwait Liberation Medal. The Board has reviewed all of the evidence in the record. Although the Board has an obligation to provide adequate reasons or bases supporting its decision, there is no requirement that each item of evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board will summarize the evidence as deemed appropriate, and the analysis below will focus specifically on what the evidence shows, or fails to show, with respect to the claims. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). In order to prevail on a claim of service connection, generally, there must be (1) medical evidence of a current disability; (2) medical, or in certain circumstances, lay evidence of in-service occurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). With regard to a present disability, post-service treatment records indicate a diagnosis of severe obstructive sleep apnea in August 2014. Thus, the current-disability criterion for service connection is met. See Shedden, supra. The Veteran’s service treatment records are silent for complaints, treatment, or diagnosis related to obstructive sleep apnea. However, the Veteran contends that he was exposed to environmental hazards, particularly oil field fires, while serving in the Persian Gulf. The Veteran’s military personnel records and service treatment records confirm that the Veteran was stationed in the Southwest Asia theater of military operations from March 1991 to June 1991. Further, in a July 1997 letter associated with the Veteran’s claims file in June 2016, VA notified the Veteran of its determination that his unit may have been exposed to nerve agents, namely sarin and cyclosarin, in the course of demolition of Iraqi weapons at Khamisiyah, Iraq during his period of service in the Persian Gulf. As such, the Board concludes that the Veteran’s exposure to environmental hazards in the Persian Gulf is consistent with the circumstances of his service. Thus, the second element of service-connection is met. See Shedden, supra. As to the third element of service connection, medical evidence must establish a nexus between the current disorder and the Veteran’s service. The Veteran underwent a VA sleep apnea examination in June 2015. The examiner noted a 2014 diagnosis of obstructive sleep apnea. The examiner indicated that the Veteran did not complain of sleep disturbance while deployed to Iraq. The Veteran reported that he began snoring loudly and experiencing a lack of air while sleeping in the years following his deployment. The examiner opined that it was less likely than not that the Veteran’s sleep apnea was caused by service, as severe obstructive sleep apnea was not pathophysiologically related to environmental hazard exposure in Southwest Asia. The Board requested a Veterans Health Administration (VHA) opinion in June 2018, which was provided in August 2018. The examiner opined that the Veteran’s sleep apnea was at least as likely as not caused by service, to include environmental exposures during the Persian Gulf War. In support of her opinion, the examiner cited several medical studies addressing the relationship between obstructive sleep apnea and environmental exposure. With regard to the final element of the Shedden analysis, the nexus element, the Board finds that the evidence is at least in equipoise as to whether this element is satisfied. The Board acknowledges the negative nexus opinion provided by the June 2015 examiner; however, the Board finds the opinion to be inadequate for adjudication purposes. In this regard, the examiner failed to provide sufficient rationale for the conclusion that the Veteran’s sleep apnea was less likely than not caused by environmental hazard exposure in Southwest Asia, thus rendering it of little probative value. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Board, however, finds the August 2018 VHA opinion to be adequate and highly probative, as the examiner reviewed the evidence of record and relied on her expertise in rendering an opinion. She also cited to medical literature in support of her opinion. See Nieves-Rodriguez, 22 Vet. App. 295. As such, the benefit-of-the-doubt will be conferred in the Veteran’s favor and his claim for service connection for obstructive sleep apnea is granted. 38 U.S.C. § 5107(b) (2012); 38 C.F.R. § 3.102 (2017); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Joseph, Associate Counsel