Citation Nr: 18150566 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 16-32 315 DATE: November 15, 2018 ORDER Entitlement to service connection for sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The Veteran’s sleep apnea is aggravated beyond the natural progress by his service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for sleep apnea, to include as secondary to PTSD, have been met. 38 U.S.C. §§ 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1999 to November 2009. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated in April 2015 by the Department of Veterans Affairs (VA) Regional Office (RO) in Los Angeles, California. The Board notes that the Veteran requested a live videoconference hearing before a Veterans Law Judge in his Substantive Appeal, dated June 2016. However, in a statement dated May 2018, the Veteran, through his attorney, cancelled his scheduled hearing. As such, the Veteran’s hearing request has been withdrawn. See 38 C.F.R. § 20.704 (e). 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 service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2018). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called “nexus” requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d) (2017). In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137 (2012); 38 C.F.R. §§ 3.307, 3.309(a) (2018); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309 (2018); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). For any disability which is proximately due to, or results from, another disease or injury for which service connection has been granted shall be considered a part of the original condition. 38 C.F.R. § 3.310 (a) (2018). Any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will be service connected. However, VA will not concede that a nonservice-connected disease or injury was aggravated by a service-connected disease or injury unless the baseline level of severity of the nonservice-connected disease or injury is established by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the nonservice-connected disease or injury. 38 C.F.R. § 3.310(b) (2018); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran asserts that his sleep apnea is secondary to his service-connected PTSD. That the Veteran has been diagnosed with sleep apnea is not in doubt. The remaining question is whether there is a relationship between his sleep apnea and his service-connected PTSD. Turning to the evidence of record, according to a June 2016 VA treatment record, the VA medical health provider specializing in sleep medicine stated, “[The Veteran] also has PTSD which is likely contributing to disrupted sleep. There is a higher prevalence of [obstructive sleep apnea] in the population of veterans with PTSD. PTSD can worsen [obstructive sleep apnea] symptoms and make treatment of [obstructive sleep apnea] more difficult.” The Board acknowledges that while there is a negative nexus opinion of record as shown in the March 2015 VA examination, this was a direct service connection opinion and the VA examiner did not provide an opinion on the secondary theory of entitlement. Therefore, the Board finds that the opinion of the June 2016 VA medical health provider is highly probative. The opinion is consistent with the other evidence of record and is supported by a rationale that the Veteran’s service-connected PTSD aggravates the Veteran’s sleep apnea. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). As stated, there are no negative nexus opinions that contradict this opinion. Accordingly, service connection for sleep apnea secondary to PTSD is warranted, and the appeal is granted. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD H. Yoo, Counsel