Citation Nr: 18145409 Decision Date: 10/29/18 Archive Date: 10/26/18 DOCKET NO. 16-35 497 DATE: October 29, 2018 ORDER Service connection for obstructive sleep apnea (sleep apnea), to include as secondary to the service-connected deviated nasal septum and right nasal obstruction, status post nasal fracture (deviated septum), is denied. FINDINGS OF FACT 1. Symptoms of difficulty breathing during service were caused by the service-connected deviated nasal septum and right nasal obstruction, status post nasal fracture. 2. The Veteran is currently diagnosed with sleep apnea. 3. Symptoms of sleep apnea did not manifest during service and are not causally or etiologically related to service. 4. The Veteran’s current sleep apnea is not caused by or worsened in severity by the service-connected deviated nasal septum and right nasal obstruction, status post nasal fracture. CONCLUSION OF LAW The criteria for service connection for sleep apnea, to include as secondary to the service-connected deviated nasal septum and right nasal obstruction, status post nasal fracture, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty from March 1998 to December 20001. This matter is on appeal from a November 2013 rating decision issued by the Regional Office (RO) in Los Angeles, California. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. See 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. §§ 3.102, 3.159, 3.326. Neither the Veteran nor the representative has raised any questions regarding the duty to notify or duty to assist. See Scott v McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when a veteran fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument). Based on the foregoing, the Board finds that all relevant documentation, including VA treatment records, VA examinations, and private treatment records, has been secured and all relevant facts have been developed. There remains no question as to the substantial completeness of the issue on appeal. 38 U.S.C. §§ 5103, 5103A, 5107; 38 C.F.R §§ 3.159, 3.326. The duties to notify and assist have been met. Legal Authority for Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See id.; Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In other words, service connection may be granted for a disability found to be proximately due to, or the result of, a service-connected disease or injury. To prevail on the issue of secondary service causation, the record must show (1) evidence of a current disability, (2) evidence of a service-connected disability, and (3) medical nexus evidence establishing a connection between the current disability and the service-connected disability. Wallin v. West, 11 Vet. App. 509, 512 (1998); Reiber v. Brown, 7 Vet. App. 513, 516-17 (1995). Service Connection for Sleep Apnea The Veteran contends that he currently has sleep apnea. The Veteran claims that he experienced symptoms of sleep apnea during service and provided lay statements in an effort to substantiate the onset of symptoms. In the alternative, the Veteran asserts that the sleep apnea is secondary to his service-connected deviated septum. First, the Board finds that the Veteran is currently diagnosed with sleep apnea. See October 2006 private treatment records, April 2016 VA examination. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence demonstrates that the currently diagnosed sleep apnea did not have its onset during, is not otherwise related to active service. The Board further finds that the weight of the evidence is against finding that the currently diagnosed sleep apnea was caused or worsened in severity by the service-connected deviated septum. Service treatment records do not reflect any history, complaints, diagnosis, or treatment for symptoms of sleep apnea. Rather, service treatment records indicate complaints and treatment for difficulty breathing through the nose at night that are attributable to the service-connected deviated septum, so have already been recognized and rated as part of the service-connected deviated septum. The Veteran was first diagnosed with sleep apnea in October 2006, five years after separation from service. January 2015 private treatment records show that a private examiner diagnosed cervical radiculitis, hyperlipidemia (high blood fats), obesity, pre-diabetes, and sleep apnea. The private medical provider noted that the Veteran is at a higher risk for weight leading health problems like sleeping problems. The private medical provider strongly recommended that the Veteran manage his weight to treat the diagnoses. In an April 2015 VA examination, the VA examiner opined that it was more likely than not that the Veteran had sleep apnea in service; however, the examiner noted severe obesity and a narrow pharyngeal airway, but did not address how these physical findings affected the Veteran’s sleep apnea. The Board finds that the April 2015 VA examination has no probative value because it does not contain a rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two); Miller v. West, 11 Vet. App. 345, 348 (1998) ("A bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record"). In the April 2016 VA examination, the VA examiner opined that the Veteran’s sleep apnea is less likely than not proximately due to or the result of the Veteran’s service-connected deviated septum. The VA examiner referenced the June 2014 x-ray, noting that the x-ray was silent for any current fracture or deviation and that the septum was midline. The VA examiner explained that the Veteran was classified as medically obese and had a well-documented history of weight problems. The VA examiner concluded that the Veteran’s current sleep apnea was due to his medical obesity, which is not related to active duty service, rather than to the service-connected deviated septum. The Veteran has repeatedly reported difficulty sleeping and feeling fatigued. See VA treatment records from June 2016 to February 2017. The Veteran claims that he experienced symptoms of sleep apnea during service, adding that his spouse and peers observed sleep apnea symptoms while he was in service. See October 2014 Letter from the Veteran. The Veteran also submitted October 2014 lay statements from his spouse, and a fellow Veteran, L.R. The spouse’s statement claimed that she met the Veteran while he was on active duty, and that she observed the Veteran snore, gasp for air, and stop breathing while he was sleeping during active duty service. In the L.R. lay statement, L.R. claimed that he was stationed at the same infantry school as the Veteran and wrote that the Veteran snored loudly and took deep breathes while he was sleeping. L.R. furthered that these symptoms caused him to awake from sleep. As a lay person, the Veteran and these lay statements are competent to report any sleep apnea symptoms observed at any given time; however, under the specific facts of the case that show medically that the in-service abnormal breathing symptoms were attributed to the deviated septum (for which the Veteran is already service connected and rated), the Veteran and others offering such lay statements do not have the requisite medical training or credentials to be able to render a competent medical opinion regarding the cause of the sleep apnea, that is, to medically differentiate the symptoms of deviated septum during service from any alleged symptoms of sleep apnea. The etiology of the sleep apnea is a complex medical etiological question dealing with the origin and progression of the respiratory system, and sleep apnea is a disorder diagnosed primarily on symptoms, clinical findings, and physiological testing. For these reasons, the lay evidence does not substantiate an in-service event, including symptoms of sleep apnea claimed to have occurred during service. Regarding the theory of secondary service connection, as noted above, the April 2016 VA examiner opined that it was unlikely that the service-connected deviated septum caused the sleep apnea. The VA examiner identified a more likely cause of the claimed symptoms, namely, a history of weight problems, noting that weight loss had been recommended for improvement of sleep apnea. The examiner also reasoned that the June 2014 x-ray was silent for any current fracture or deviation. The examiner concluded with the opinion that the Veteran’s sleep apnea was caused by obesity that was not attributable to active duty service. Taken in light of other evidence of record, the VA examiner’s opinion weighs against a relationship between service-connected deviated septum and sleep apnea. (Continued on the next page)   The April 2016 VA opinion is competent and probative medical evidence because it is factually accurate and is supported by an adequate rationale. The VA examiner reviewed the claims file and fully articulated the opinions and rationale. For these reasons, service connection is not warranted on a secondary basis. 38 C.F.R. § 3.310. For these reasons, the Board finds that a preponderance of the evidence is against the Veteran’s claim of service connection for sleep apnea on a direct or secondary basis, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Danielle Costantino, Associate Counsel