Citation Nr: 18146802 Decision Date: 11/01/18 Archive Date: 11/01/18 DOCKET NO. 18-03 740 DATE: November 1, 2018 ORDER Entitlement to service connection for sleep apnea, to include as secondary to service-connected allergic rhinosinusitis, is denied. FINDING OF FACT The Veteran has sleep apnea, but it is not shown to be related to service or to have been caused or aggravated by service-connected allergic rhinosinusitis. CONCLUSION OF LAW The criteria for service connection for sleep apnea, to include as secondary to service-connected allergic rhinosinusitis, have not been met. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the U.S. Army from May 1971 to May 1974. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a January 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, the Commonwealth of Puerto Rico. The Veteran submitted a Rapid Appeals Modernization Program (RAMP) opt-in election form that was received by VA in September 2018. However, as his appeal had already been activated at the Board at that time, it was no longer eligible for RAMP. Service Connection for Sleep Apnea The Veteran contends that he has sleep apnea that is secondary to service-connected allergic rhinosinusitis. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013). Service connection may also 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). In addition, service connection may be granted on a secondary basis for disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. The Veteran’s service treatment records are devoid of any reference to complaints or treatment for sleep problems. There is no evidence that sleep apnea was diagnosed in service. In addition, although the Veteran’s service treatment records contain evidence of treatment for sinusitis, none of those records suggest a link between his sinusitis symptoms and currently diagnosed sleep apnea. An October 1974 VA examination contains a diagnosis of probable chronic sinusitis, but is silent as to sleep apnea. Subsequent treatment records from the 1970s and 1980s likewise revealed no indication of sleep apnea or sleep-related symptoms. The first record of treatment for sleep apnea is from April 2014, when a sleep study resulted in a positive diagnosis. The Veteran was examined for VA compensation purposes in December 2016. The examiner noted an initial diagnosis of sleep apnea in April 2014. After examining the Veteran and reviewing the claims file, the examiner opined that it was less than 50 percent likely that the Veteran’s sleep apnea was proximately due to or the result of his service-connected allergic rhinosinusitis. The examiner explained, in part: Obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles support the soft palate, the triangular piece tissue hanging from the soft palate (uvula), the tonsils, the side walls of the throat and the tongue. When the muscles relax, the airway narrows or closes as the person breathe[s] in, and the person can’t get an adequate breath in. This may lower the level of oxygen in the blood. The brain senses this inability to breathe and briefly rouses the person from sleep so that the person can reopen the airway. The only evidence in support of the claim consists of the Veteran’s lay statements. The Veteran is competent to relate symptoms within the realm of his personal knowledge, just as he is competent to relate what he has been told by an examiner. Layno v. Brown, 6 Vet. App. 465, 469-70 (1994); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, he is not competent to offer opinions on complex medical questions requiring specialized knowledge, such as the physiological causes of his sleep apnea. As discussed above, a VA medical professional has reviewed the record and opined that the Veteran’s sleep apnea is caused by dysfunction of muscles in the back of his throat, and is less likely than not causally related to his sinusitis. The examiner addressed the Veteran’s medical history, the causes of his sleep apnea, and his lay contentions regarding the onset of his sleep apnea. As such, the opinion is entitled to significant probative weight. See, e.g., Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The preponderance of the evidence is against a finding that the Veteran’s sleep apnea is related to service or to have been caused or aggravated by service-connected allergic rhinosinusitis. The appeal is denied. DAVID A. BRENNINGMEYER Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Minot, Associate Counsel