Citation Nr: 18145380 Decision Date: 10/30/18 Archive Date: 10/26/18 DOCKET NO. 16-102 75 DATE: October 30, 2018 ORDER Entitlement to service connection for sleep apnea is granted. FINDING OF FACT The Veteran’s sleep apnea had its onset during active service. CONCLUSION OF LAW The criteria for service connection for sleep apnea have been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active naval service from November 1980 to November 2000. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. Service Connection – Sleep Apnea The Veteran has asserted that he has sleep apnea that had its onset during active service, or is otherwise etiologically related to such service. Service treatment records (STRs) are silent for a diagnosis of sleep apnea while the Veteran was in active service. However, at the time of his August 2000 separation examination, the Veteran reported that he had experienced frequent trouble sleeping. Further review of the STRs shows that the Veteran was treated for insomnia, for which he was prescribed Ambien. A review of the post-service medical evidence of record shows that the Veteran was diagnosed with sleep apnea by private sleep study in April 2015. He was prescribed a CPAP machine for treatment. The record includes multiple lay statements from the Veteran’s spouse, daughter, brother, and shipmate. Generally, those record statements indicate that the Veteran experienced symptoms of sleep apnea while in active service, to include excessive snoring and observed apneic events. In July 2015, a VA medical opinion was obtained. Based on a review of the record, the examiner opined that it was less likely as not that the Veteran’s sleep apnea was proximately due to or the result of a service-connected disability. In this regard, the examiner noted that while there was peer-reviewed medical literature that supported a finding that untreated sleep apnea contributed to the development of hypertension, the bulk of the peer-reviewed medical literature did not support a finding that hypertension caused or exacerbated sleep apnea. In February 2018, an additional VA medical opinion was obtained. At that time, the examiner opined that the Veteran’s sleep apnea was less likely as not incurred in or caused by the claimed in-service injury, event, or illness. In this regard, the examiner noted that the Veteran’s body mass index at separation was 24.6 (normal), and at the time of his sleep study it was 25.3 (overweight), indicative of mild weight gain. The examiner also noted that the Veteran did not report sleep apnea in service, did not have a sleep study during service, and there were 15 years between the time of his separation from service and eventual diagnosis of sleep apnea. The examiner also noted that just because the Veteran was reported to be a loud snorer in service, did not mean it was related to his current sleep apnea. Also, the examiner noted the lay statements of record indicating the Veteran experienced witnessed apneic events in service, but discounted them, relying instead on the Veteran’s very mild weight gain since his separation and the length in time from separation to diagnosis of support the negative conclusion reached. The Board finds the February 2018 VA medical opinion to be inadequate for adjudication purposes. In this regard, the examiner did not fully consider the lay statements of record regarding the onset and continuity of the Veteran’s symptoms. Further, the examiner relied heavily on the Veteran’s very slight increase in his BMI since his separation from service. However, the examiner also noted that the Veteran’s weight gain since separation was mild, which seems inconsistent with a finding that increased weight caused his sleep apnea. Further, the examiner noted that the Veteran did not have complaints of sleep apnea in service. However, the Veteran did report sleep impairment in service, the fact that he was never afforded a sleep study is not a fact that can be held against him in considering entitlement to service connection. As the opinion is not adequate, it cannot serve as the basis of a denial of entitlement to service connection. The Board notes that lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F .3d 1331 (Fed. Cir. 2006). The Veteran, his spouse, his daughter, and his fellow shipmates are competent to identify sleep impairment, to include loud snoring and witnessed apneic events. In sum, the Veteran reported sleep impairment during active service. The Veteran’s spouse, daughter, and shipmate have all reported that the Veteran experienced sleep apnea symptoms during service. The Veteran has a current diagnosis of sleep apnea. The VA medical opinion against the claim is inadequate and so, is of little probative values. Accordingly, the Board finds that the evidence for and against the claim of entitlement to service connection for sleep apnea is at least in equipoise. Therefore, reasonable doubt must be resolved in favor of the Veteran and entitlement to service connection for sleep apnea is warranted. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs