Citation Nr: 18152901 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 14-05 233 DATE: November 27, 2018 ORDER The appeal for service connection for a benign celiac access mass, including as due to herbicide exposure, is dismissed. Service connection for obstructive sleep apnea (OSA) as secondary to service-connected diabetes mellitus type II is granted. FINDINGS OF FACT 1. Per the Veteran’s November 2016 Board testimony, prior to the promulgation of a decision in the present appeal, the Veteran asked to withdraw the issue of service connection for a benign celiac access mass. 2. The Veteran is currently diagnosed with obstructive sleep apnea; the current OSA is the result of the service-connected diabetes mellitus type II. CONCLUSIONS OF LAW 1. The criteria for the withdrawal of a substantive appeal have been met regarding the appeal for service connection for a benign celiac access mass. 38 U.S.C. § 7105; 38 C.F.R. § 20.204. 2. Resolving reasonable doubt in the Veteran’s favor, the criteria for service connection for obstructive sleep apnea as secondary to the service-connected diabetes mellitus have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, served on active duty from March 1967 to July 1969. 1. Withdrawal of appeal for service connection for a benign celiac access mass Under 38 U.S.C. § 7105, the Board may dismiss any appeal that fails to allege a specific error of fact or law in the determination being appealed. A veteran may withdraw a substantive appeal by telling the Board of the decision to withdraw either in writing or on the record at a Board personal hearing. 38 C.F.R. § 20.204. Per the November 2016 Board hearing testimony, the Veteran asked to withdraw the issue of service connection for a benign celiac access mass. As the Veteran has withdrawn the appeal regarding service connection for a benign celiac access mass, there remains no allegation of errors of fact or law for appellate consideration as to this issue. Accordingly, the Board does not have jurisdiction to review this issue, and the issue of service connection for a benign celiac access mass will be dismissed. 2. Service connection for obstructive sleep apnea The Veteran asserts that the service connected PTSD, diabetes mellitus, and/or degenerative joint disease of the thoracolumbar spine, caused or contributed to the development of OSA. See May 2012 Correspondence. Initially, the Board finds that the Veteran is currently diagnosed with obstructive sleep apnea. January 2014 and April 2014 VA examination reports reflect a diagnosis of OSA. After a review of all the lay and medical evidence of record, the Board finds that the evidence is at least in equipoise on the question of whether the current OSA is secondary to the service-connected diabetes mellitus type II. 38 C.F.R. § 3.310. In an August 2018 VHA medical opinion, the VA medical expert opined that it is at least as likely as not that the Veteran’s current OSA is the result of the service-connected diabetes mellitus. In support of the opinion, the VA medical expert in August 2018 discussed several medical studies that researched the relationship between fasting insulin levels and the severity of OSA in patients with a body mass index (BMI) of 29 or greater, studies that suggest diabetes may be a causal factor in the development of sleep disordered breathing including OSA, and studies revealing people with diabetes have a higher degree of periodic breathing or breathing instability. Turning to the Veteran’s case, the VA medical expert noted that it is evident that the Veteran gained weight and that his BMI had increased since service separation that likely impacted the development of OSA. Additionally, the VA medical expert opined that OSA may be a development of an autonomic dysfunction from diabetes, explaining that the dysfunction is a condition of the autonomic nervous system not working properly and affecting functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels. The VA medical expert noted that the Veteran also noted that the Veteran had chronic use of sedative medications prescribed for the service-connected back and neck pain, which could worsen the OSA symptoms. Accordingly, the VA medical expert concluded that available research confirms a causal relationship between diabetes and OSA. (Continued on the next page)   Based on the foregoing, and resolving reasonable doubt in favor of the Veteran, the Board finds that the criteria for service connection for obstructive sleep apnea, as secondary to the service-connected diabetes mellitus type II, have been met. 38 C.F.R. §§ 3.102, 3.310. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD E. Choi, Associate Counsel