Citation Nr: 18158082 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 15-35 315A DATE: December 14, 2018 ORDER Service connection for sleep apnea is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his sleep apnea is secondary to his service-connected diabetes mellitus, type II. CONCLUSION OF LAW The criteria for entitlement to service connection for sleep apnea have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1963 to August 1963 and January 1968 to March 1969, with service in Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision by the Department of Veterans Affairs (VA). This case was most recently remanded in May 2017 for further development; it has since been re-assigned to the undersigned. After the Veteran filed his substantive appeal (VA Form 9), service connection for hypertension was granted in a June 2018 rating decision. Because that decision represents a full grant of the benefit sought, the issue is not before the Board. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Entitlement to service connection for sleep apnea. Establishing secondary service connection requires evidence of: (1) a current disability (for which secondary service connection is sought); (2) a service-connected disability; and (3) that the current disability was either caused or aggravated by the service-connected disability. 38 C.F.R. § 3.310(a); see also Allen v. Brown, 7 Vet. App. 439 (1995). When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the Veteran. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. If the preponderance of the evidence is against the claim, the claim is to be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). The Veteran contends his sleep apnea is secondary to his service-connected diabetes. See November 2018 statement; November 2018 appellate brief. The Veteran has been diagnosed with sleep apnea. See VA treatment records dated August 2015, June 2017 and July 2017; April 2015 private physician letter. The Veteran’s wife corroborates that since returning from Vietnam he has frequently woken up, snored loudly, and stopped breathing while sleeping; has been tired and drowsy during the daytime; and frequently fell asleep while driving. See July 2015 statement. Notably, the Board assigns significant probative weight to the June 2017 VA examiner’s opinion that the Veteran’s sleep apnea and diabetes are directly related. The Board notes that the February 2018 VA examiner opined that sleep apnea was not caused or aggravated by his diabetes mellitus. However, in so opining, the examiner cited a study which found that the relationship between sleep apnea and type 2 diabetes may be bidirectional in nature given that diabetic neuropathy can affect central control of respiration and upper airway neural reflexes, promoting sleep-disordered breathing. See February 2018 VA medical opinion. Moreover, the examiner noted that “it is at least as likely as not that current internal medicine, endocrine and hypopnea literature continue to agree that current objective, medically-based, clinical evidence remains steadfast on an independent association between Diabetes Mellitus, Type II and Obstructive Sleep Apnea.” As such, the Board finds that while stating that sleep apnea and diabetes mellitus are not related, the supporting rationale seems to actually draw a relationship between the two. As such, the Board views the opinion as one favorable to the Veteran. The Board is also cognizant of the July 2017 and August 2015 VA opinions that the Veteran’s sleep apnea is less likely due to his diabetes. However, the July 2017 examiner states the sleep apnea is related to multiple medical risk factors but does not specify which; and, the August 2015 opinion does not consider the wife’s lay statements or the medical treatise submitted by the Veteran. As such, resolving reasonable doubt in the Veteran’s favor, service connection is warranted. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Roe, Associate Counsel