Citation Nr: 18151970 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-41 408 DATE: November 20, 2018 ORDER Entitlement to service connection for sleep apnea is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, sleep apnea is at least as likely as not related to active duty 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(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Navy from July 1980 to July 2006. The Board notes that the Veteran currently has four separate appeals before the Board, three of which are not yet ripe for adjudication. The case at hand was certified to the Board in April 2017. The Veteran’s additional cases were certified to the Board in March and May of 2018, and will be addressed in docket order at a later date. Entitlement to Service Connection for Sleep Apnea The Veteran is claiming entitlement to service connection for sleep apnea. He asserts that his sleep apnea developed over a period of years while he served on active duty. Specifically, under the relevant laws and regulations, 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. Generally, the evidence 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. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Based on the evidence of record, the Board determines that service connection is warranted for sleep apnea. Initially, the Board notes that the Veteran’s service treatment records (STRs) do not exhibit symptoms of sleep apnea or treatment for sleep apnea. During his June 1980 entrance examination and June 2006 separation examination, there are no indications of the symptoms of sleep apnea. In June 2014, eight years after his July 2006 discharge from active duty he underwent a sleep study, which resulted in a diagnosis of sleep apnea. However, in support of the Board’s finding, probative medical opinions firmly demonstrate a nexus relationship between the Veteran’s sleep apnea and military service. Specifically, the evidence of record includes opinions from the Veteran’s private treating physicians submitted in October 2014, June 2015, and October 2016. The physicians opined that it was more likely than not that the Veteran’s sleep apnea developed during active duty service. In the October 2014 and June 2015 opinions the physician specifically found that the Veteran’s sleep apnea likely took 20 years to develop. The physician also reviewed his medical records and STRs, and took into consideration the Veteran’s medical history, which the physician found exhibited potential symptoms of untreated sleep apnea. Further, in the October 2016 opinion the physician took the Veteran’s weight gain into consideration, stating that aging and weight gain may influence sleep apnea, but that it does not come on suddenly but slowly develops and worsens over many years. The physician opined that despite the weight gain, it was more likely than not that the Veteran suffered from sleep apnea during ative duty service. The Board finds that these private medical opinions provide probative evidence regarding the second and third Shedden elements, thus establishing the nexus relationship required for service connection for the Veteran’s sleep apnea. Additionally, credible lay evidence also supports the Board’s finding. The Veteran submitted letters, dated June 2014 and September 2014, from three fellow soldiers regarding the onset of his sleep apnea symptoms. The soldiers state that while on active duty they shared a bunk with the Veteran. They each observed excessive snoring, stopped breathing, gasping for air, and choking during sleep. They often woke him when they heard choking. They also observed daily fatigue and noted that he often took naps during lunch as a result of the fatigue. Further, the Veteran submitted a letter from his wife from August 2014, in which she stated that they had been married for over 12 years. She stated that during their marriage she witnessed excessive snoring, stopped breathing, and gasping for air. She also observed daily fatigue and frequent headaches. These detailed, credible, and consistent statements corroborate the private medical opinions, which found that the Veteran’s sleep apnea more likely than not began in service. The evidence of record includes two negative opinions by VA examiners in March 2015 and July 2016, which denied service connection for sleep apnea. The examiners found that the Veteran likely developed sleep apnea after service due to weight gain. However, these opinions are not sufficient to rebut the private physicians’ opinions as they failed to address the private physicians’ findings that the Veteran’s sleep apnea developed slowly over a period of approximately 20 years. Further, the opinions did not take into consideration the competent and credible lay statements. Thus, the probative value of the negative opinions is outweighed by the private physicians’ medical opinions. Considering the private medical opinions concluding that the Veteran’s sleep apnea is related to active duty service, the corroborating lay statements, and resolving all reasonable doubt in favor of the Veteran, the Board finds that that the evidence is at least in equipoise. Therefore, entitlement to service connection for sleep apnea is granted. 38 U.S.C. 5107 (b); 38 C.F.R. 3.102. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Page-Nelson, Associate Counsel