Citation Nr: 18146729 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 16-34 231 DATE: November 1, 2018 ORDER Entitlement to service connection for sleep apnea is granted. FINDING OF FACT The Veteran’s sleep apnea is shown to have had its initial onset during his active military service. CONCLUSION OF LAW The criteria for entitlement to service connection for sleep apnea have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Navy January 1985 through January 2005. He was honorably discharged. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Diego, California. Entitlement to service connection for sleep apnea Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease initially diagnosed after service 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 for a disability requires evidence of: (1) a current disability; (2) a disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). A diagnosis of obstructive sleep apnea is well established. Shedden element (1) is thereby met. The Board finds that there is sufficient evidence to meet Shedden element (2), in-service incurrence. The Veteran’s service treatment records (STRs) are silent as to any complaints, treatment, or diagnosis of any chronic sleep disorder, to include sleep apnea. However, he has provided a history of being told that he displayed in-service symptoms of snoring, fatigue, daytime sleepiness, gasping for air, irregular sleeping patterns, and falling asleep during duty. He states he never reported these symptoms while on active duty because he “wasn’t aware that it was a symptom of a serious disorder.” The Veteran also stated he felt embarrassed to tell the doctor about his sleeping condition because he believed the medical clinic would only treat serious chronic issues and medical emergencies. His spouse recalls a similar history. Also of record is a statement from M.D., who reports being stationed with the Veteran between November 2003 and January 2005. M.D. stated he observed the Veteran fall asleep on several occasions and verbally counselled the Veteran for “not being attentive” in training. M.D. believed the Veteran was suffering from a medical disorder because he observed the Veteran fall asleep within one minute and begin snoring loudly. Further, M.D. advised the Veteran to seek medical attention to address sleeping abnormalities. Turning to Shedden element (3), the record includes an opinion from Dr. C.S., a Board-certified physician of sleep medicine. Dated in January 2015, Dr. C.S. determined that it was as likely as not that the Veteran’s sleep apnea had its initial onset during his active military service. Her conclusion was based upon the Veteran’s medical history, a review of his current symptoms and past symptoms as reported by the Veteran. She explained that obstructive sleep apnea develops and worsens progressively over the course of years. In the Veteran’s case, she believed it took 15-20 years for the disorder to reach current levels due to the disease’s progression. Her expert opinion is that the Veteran developed significant sleep apnea between 1994 and 1999. Consideration has been given a negative VA opinion. However, that opinion is no more or less probative than Dr. C.S.’s positive opinion. Such places the evidence of there being a medical nexus in equipoise. The Veteran has satisfied the third Shedden element for service connection. In summary, the Board finds there is competent and probative evidence showing the Veteran’s sleep apnea manifested in service. Entitlement to service connection for sleep apnea is warranted. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Mahmoudi, Associate Counsel