Citation Nr: 18158050 Decision Date: 12/18/18 Archive Date: 12/14/18 DOCKET NO. 15-00 392 DATE: December 18, 2018 ORDER Entitlement to service connection for obstructive sleep apnea is granted. REMANDED Entitlement to a compensable rating for hypertension is remanded. Entitlement to a compensable rating for erectile dysfunction is remanded. FINDING OF FACT The Veteran’s sleep apnea is etiologically related to active service. CONCLUSION OF LAW The criteria for service connection for sleep apnea are met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from April 1980 to April 2000. In May 2018, the Veteran testified at a Board hearing. The transcript is of record. 1. Entitlement to service connection for obstructive sleep apnea Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. “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. Shineski, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The Veteran contends his sleep apnea is related to active service. For the following reasons, the Board finds that service connection for sleep apnea is warranted. The Veteran attended a VA examination in March 2014. The examiner opined that it is less likely than not that the sleep apnea was incurred in or was caused by an in-service injury, event, or illness. The examiner noted that the Veteran was diagnosed with sleep apnea 11 years after military separation. The examiner listed several risk factors and medical conditions with a prevalence of sleep apnea and pointed out, hypertension, for which the Veteran is service connected, is not one of those medical conditions. The examiner concluded that the medical literature does not support that hypertension causes or aggravates sleep apnea. In October 2016, the Veteran provided a disability benefits questionnaire (DBQ) by Dr. C.S., who noted a history of snoring, poor sleep, breathing pauses during sleep, and daytime hypersomnolence. In a separate statement dated February 2015, Dr. C.S.opined that it is more likely than not that the Veteran had undiagnosed and untreated sleep apnea on active duty based on her review of the medical records, service treatment records, and sleep history. According to Dr. C.S., based on reports from others that he would snore disruptively and have trouble breathing when asleep, the Veteran’s sleep apnea developed between 1986 to 1991. When making a decision, the Board must consider all the evidence of record, to include lay statements. 38 U.S.C. § § 5107(b), 7104(a); 38 C.F.R. § 3.303(a). In May 2018, the Veteran testified that, prior to service no one complained about his snoring; however, in service, coworkers would throw things at him to wake him up and request to not be in the same room as him due to his disruptive snoring. The Veteran provided buddy statements from fellow servicemen, who all reported that the Veteran snored loudly with long breath pauses during service. Additionally, the Veteran’s spouse reported that the Veteran has suffered from severe and chronic snoring since service. The Board finds the Veteran, his spouse and coworkers are competent and credible to testify as to the Veteran’s observable symptoms. See Barr v. Nicholson, 21 Vet. App. 303 (2007). As such, the Board gives probative weight to the lay evidence of record. Furthermore, the Board gives significant weight to the opinion of Dr. C.S. This opinion was conducted by an expert in the field of sleep medicine, who reviewed the record and conducted a physical examination. Dr. C.S.’s opinion is supported by a thorough rationale with a well-reasoned medical explanation with citations to the evidence of record. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Conversely, the Board affords little weight to the opinion of the VA examiner. The examiner recited the risk factors and medical conditions related to sleep apnea but failed to provide a rationale relating the risk factors to the case at hand. Additionally, the examiner did not consider or address the Veteran’s statements, as well as the lay statements of record, reporting disruptive snoring and difficulty breathing during sleep while in service. As such, the Board finds that service connection for sleep apnea is warranted. REASONS FOR REMAND The Veteran last underwent a VA examination in July 2017 for his erectile dysfunction and hypertension. At the hearing in May 2018, the Veteran testified that his symptoms have increased since his last VA examination. Based on the contention that his symptoms worsened, a new VA examination is warranted to determine the current severity of the Veteran’s hypertension and erectile dysfunction. The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Schedule the Veteran for a VA medical examination to determine the current severity of his service-connected erectile dysfunction and hypertension. The electronic claims file, to include a copy of this remand, must be reviewed in conjunction with the examination. Any appropriate evaluations, studies, and testing deemed necessary by the examiner should be conducted, and the results included in the examination report. The examiner should consider and address the testimony and lay statements of record. If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. A complete rationale should be given for all opinions and conclusions rendered. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 3. Finally, readjudicate the appeal. If the benefits sought on appeal remain denied, issue a supplemental statement of the case and return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. A. Prinsen, Associate Counsel