Citation Nr: 18154699 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 14-24 111 DATE: November 30, 2018 ORDER Entitlement to service connection for obstructive sleep apnea (OSA), including as secondary to posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT The evidence is in equipoise as to whether the Veteran’s OSA is related to service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for OSA have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1968 to June 1970. This matter is on appeal of an August 2013 rating decision. In May 2018, in accordance with 38 U.S.C. § 7109 and 38 C.F.R. § 20.901, the Board requested a medical expert opinion from the Veterans Health Administration (VHA). A VHA medical opinion was rendered in October 2018. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted if a disability is proximately due to or the result of a service-connected disability or if aggravation of a nonservice-connected disorder is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310. When there is an approximate balance in the evidence regarding the merits of an issue material to the determination of the matter, reasonable doubt will be resolved in each such issue in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. An appellant need only demonstrate that there is an approximate balance of positive and negative evidence to prevail. To deny a claim on its merits, the evidence must preponderate against the claim. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Alemany v. Brown, 9 Vet. App. 518 (1996). The Veteran contends that his currently diagnosed OSA either had its onset in service or is proximately due to or aggravated by his service-connected PTSD. The Board concludes that the Veteran has a current diagnosis of OSA that his VA treating nurse practitioner and physician, in respective April 2014 and May 2014 letters, opined is related to his service-connected PTSD. Moreover, an October 2018 VHA expert opinion indicates that recent research suggests the risk of OSA likely increases with the severity of PTSD symptoms. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.310. Although both the Veteran and his brother, in June 2014 statements, indicate that he had sleep issues manifested by loud snoring while still in service, his service treatment records show no relevant complaints, findings, treatment or diagnoses. Further, the October 2018 VHA physician, while acknowledging the Veteran’s and his brother’s statements about his symptoms during service, opined that it was less likely as not that he had OSA in service as snoring does not necessarily suggest a diagnosis of OSA. A January 2013 VA examination report shows that the Veteran was initially diagnosed with OSA in 2001. December 2012 and January 2013 VA examiners opined that the Veteran’s OSA was unrelated to his PTSD, finding that medical literature did not show that PTSD caused OSA. The December 2012 and January 2013 VA examiners did not address whether his service-connected PTSD aggravated his diagnosed OSA. However, the April 2014 VA clinician noted that recent medical literature showed a correlation between PTSD and OSA and the October 2018 VHA expert acknowledged that recent research did suggest the risk of OSA likely increases with the severity of PTSD symptoms. The April 2014 clinician etiologically linked the Veteran’s OSA to his service-connected PTSD with a rationale based on medical literature, as did the VA treating physician, although the treating physician did not provide any rationale for his opinion. Accordingly, based on the opinions of record, the Board finds that the evidence is at least in equipoise as to whether the Veteran’s service-connected PTSD caused or aggravated his OSA. Therefore, the Board resolves any reasonable doubt in favor of the Veteran and finds that entitlement to service connection for OSA as secondary to PTSD is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Wells-Green