Citation Nr: 18152940 Decision Date: 11/26/18 Archive Date: 11/26/18 DOCKET NO. 15-39 492 DATE: November 26, 2018 ORDER Entitlement to service connection for sleep apnea is granted. FINDING OF FACT The Veteran’s sleep apnea 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 Marine Corps August 1978 through January 2000. He was honorably discharged. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. 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 in-service symptoms of snoring, gasping for air, choking, snorting, daytime fatigue. He states he never reported these symptoms while on active duty because “the culture of the Army back then wouldn’t allow me the opportunity to seek medical attention … without having [repercussions].” The Veteran also stated seeking medical treatment raised red flags. His spouse recalls a similar history. Also of record is a statement from K.P., who was stationed with the Veteran between April 1986 and September 1995. K.P. stated he observed the Veteran snore loudly every night. K.P. worried about the Veteran because he observed the Veteran stop breathing. Further, K.P. noticed a worsening of the Veteran’s symptoms over the nine years they shared sleeping quarters. Turning to Shedden element (3), the record includes an opinion from Dr. S.S., a Board-certified Otolaryngologist with a boarded subspecialty of sleep medicine. Dated in October 2014, Dr. S.S. determined that it was as likely as not that the Veteran’s sleep apnea had its initial onset during his active military service. His conclusion was based upon the Veteran’s medical history, a review of his current symptoms and past symptoms as reported by the Veteran. Dr. S.S. believes the Veteran’s sleep apnea was “most certainly” present during military service. A second opinion provided by Dr. G.K., a private physician, explained the Veteran’s sleep apnea is more likely than not aggravated by the medication treating current service-connected disabilities. Consideration has been given a negative VA opinion. However, that opinion is no more or less probative than Drs. S.S. and G.K.’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