Citation Nr: 18158080 Decision Date: 12/18/18 Archive Date: 12/14/18 DOCKET NO. 14-13 737 DATE: December 18, 2018 ORDER Entitlement to service connection for sleep apnea syndrome is denied. FINDING OF FACT The preponderance of the evidence is against finding that the Veteran has sleep apnea that either began during or was otherwise caused by his military service. CONCLUSION OF LAW The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110, 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 from July 1976 to January 1979 and from July 1982 to February 1997. The Veteran was diagnosed with obstructive sleep apnea (OSA) in 2012, approximately fifteen years after his separation from active military service. In an April 2013 statement in support of this claim, the Veteran asserted that his sleeping patterns changed in the 1980s during a period of time when he lost several friends and members of his command, and the change in sleep pattern continued into his next two tours where he was required to work and be available 24 hours a day, 7 days a week. The record also contains lay statements from the Veteran’s spouse and a fellow service member that note in-service symptoms of problems sleeping, daytime sleepiness and daytime napping, extremely loud snoring, and interrupted breathing during his sleep. Notably, the Veteran’s spouse reported consistent snoring since the 1990s and recalled receiving letters from her husband while he was deployed indicating he was having problems sleeping. Service treatment records indicate that the Veteran generally denied sleep problems, but experienced acute periods of sleep difficulty. On an August 1977 officer physical examination questionnaire, the Veteran denied experiencing insomnia, morning tiredness, or easy fatigability. On his July 1996 retirement physical, the Veteran specifically denied frequent trouble sleeping. There is no report or notation of a sleep disorder, sleep problems, snoring, or breathing problems. During a September 1986 treatment encounter, the Veteran reported feeling tired and working seventeen-hour days for a two-week span. He also reported symptoms of illness, to include cough, dizziness, sore throat, and runny nose. In October 2016 a VA examiner opined that it was less likely than not that the Veteran’s sleep apnea either began or was causally related to his military service. The examiner noted a lack of symptomatology in service records and a negative response to sleep issues inquiry on the retirement physical. The examiner also noted the significant amount of time between the Veteran’s active service and his sleep apnea diagnosis. However, the examiner did not address the credible lay statements from the Veteran, his spouse, or his fellow service member about the symptoms the Veteran experienced during service. Based on the foregoing, the Board sought an expert medical opinion from a somnologist. In August 2018, a somnologist opined that the Veteran’s sleep apnea could not be attributed to, or associated with, his military service. As rationale for the opinion, the clinician noted an absence of objective medical evidence indicating snoring, sleep disturbance, or other symptoms of OSA during the Veteran’s active service or since separation from service. The clinician noted that the Veteran’s service medical records included denials of insomnia and trouble sleeping, demonstrated a normal BMI, and demonstrated a normal nose, mouth, and throat. The clinician noted that while the lay statements associated with the record are suggestive of sleep apnea during the Veteran’s active service, the medical record lacked any corroborating presence of reported symptoms during the relevant period of service or soon after separation from service. Lastly, the clinician noted the significant amount of time between the Veteran’s separation from service and his diagnosis of sleep apnea. The Board has carefully reviewed the evidence of record and finds that the preponderance of the evidence is against the award of service connection for sleep apnea. The evidence of record fails to demonstrate that the Veteran’s experienced an onset of sleep apnea syndrome in service that is causally related to his current OSA. The Veteran’s service records include specific denials of sleep problems, other than one notation correlated with a seventeen-hour work week. While the Veteran asserts he experienced difficulty sleeping, snoring, daytime sleepiness, and interrupted breathing during sleep while in service, the record includes no diagnosis or medical assessment associating these symptoms with sleep apnea during the Veteran’s active service. Further, the Veteran did not seek treatment for any of these symptoms during active service or for several years after his separation from service. Notably, the Veteran sought treatment for several other conditions during active service, both major and minor, yet there is only one mention of sleep difficulty in the service medical records. While the absence of treatment is not determinative, it is persuasive. The Board acknowledges that the reported sleep symptoms are often associated with sleep apnea when combined with objective testing to make a medical diagnosis. However, in this case, the Veteran was not diagnosed with sleep apnea until almost fifteen years after his separation from service. Moreover, both the VA examiner and the VHA clinician found there was no causal link between the Veteran’s current OSA and his military service. Taken together, these opinions establish that the Veteran’s sleep apnea is less likely as not related to an in-service injury, event, or disease, including reported symptoms of snoring, daytime sleepiness, and interrupted breathing during sleep. The combined rationales are probative and afforded great weight. The combined rationales are grounded in an accurate medical history, consideration of the lay assertions of record, and objective medical examinations. The combined rationales also provide an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Of note, no medical evidence of record has been offered to refute either medical opinion. (Continued on the next page)   While the Veteran, his spouse, and his fellow servicemember believe that the Veteran’s sleep apnea is related to an in-service injury, event, or disease, they are not competent (meaning qualified by medical training and expertise) to provide a nexus opinion in this case. While the Veteran experienced in-service symptoms of snoring, sleep difficulty, and interrupted breathing, the record fails to demonstrate that those symptoms are diagnostic of his current sleep apnea. Neither the Veteran, nor his spouse or fellow servicemember have been shown to possess the training or knowledge necessary to make a medical determination in this case. This issue is medically complex, as it requires knowledge of systems in the body and interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the medical evidence of record to include service medical records and medical opinions. Based on the foregoing, the Board finds that service connection for sleep apnea is not warranted. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. I. Sims, Associate Counsel