Citation Nr: 19150331 Decision Date: 06/27/19 Archive Date: 06/27/19 DOCKET NO. 16-55 143 DATE: June 27, 2019 ORDER Service connection for sleep apnea secondary to service-connected depressive disorder with posttraumatic stress disorder (PTSD) and adenocarcinoma of the prostate is denied. FINDING OF FACT The Veteran’s sleep apnea is not caused or aggravated beyond normal progression by service-connected depressive disorder with PTSD and adenocarcinoma of the prostate. CONCLUSION OF LAW The criteria for service connection for sleep apnea secondary to service-connected depressive disorder with PTSD and adenocarcinoma of the prostate have not been satisfied. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from September 1970 to June 1973, to include service in the Republic of Vietnam. Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an 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. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury shall be service connected. 38 C.F.R. § 3.310. The Veteran asserts his sleep apnea is secondary to his service-connected psychiatric disorder, or secondary to his service-connected prostate cancer. The Veteran has a current diagnosis for sleep apnea. For example, at his June 2015 Department of Veterans Affairs (VA) examination he was diagnosed with sleep apnea. Thus, the remaining question is whether the current sleep apnea is related his service-connected disabilities. Service treatment records show no complaints, diagnosis, or treatment related to sleep apnea. During the June 1975 separation examination, evaluation was normal. The examining physician noted the Veteran was in good health. During the June 2015 VA examination the examiner noted the Veteran was diagnosed with sleep apnea during a 2002 sleep study, many years after the Veteran’s separation from service. During the June 2015 examination, the Veteran was interviewed by the examiner who also reviewed the pertinent medical history and performed an examination. The examiner reported treatment records showed a sleep study request in October 2001 noting that another person witnessed apneas by the Veteran during his sleep, and the Veteran would awaken with choking or gasping sensation, disruptive snoring, daytime sleepiness, and the Veteran would be tired in the morning after sleeping at night. She reported the sleep study confirmed sleep apnea and the Veteran underwent treatment to help with respiratory-related sleep disturbances, but his PTSD and depression continued to cause him to awaken at night due to nightmares. The examiner reported when that happens the Veteran has trouble falling back to sleep and the Continuous Positive Airway Pressure (CPAP) machine is not helpful with this type of insomnia. The examiner opined that it is less likely as not that the Veteran’s sleep apnea is proximately due to, the result of, or was aggravated by service-connected PTSD/depressive disorder and its psychologically related sleep disturbances. In support of this conclusion, the examiner explained that current medical literature does not conclusively link the development of, or aggravation of sleep apnea to PTSD/depressive disorder issues and its psychologically-related sleep disturbances. She explained that the cause of sleep apnea is not fully understood, but it has been associated with obesity, which the Veteran developed in the decades after military service. In October 2016 VA obtained a supplemental medical opinion. The same examiner reported the Veteran’s sleep apnea was diagnosed during a sleep study in 2002. She reported prostate cancer was diagnosed during a prostate biopsy in 2007. She opined that it is less likely as not that the Veteran’s service-connected prostate cancer aggravated the Veteran’s diagnosed sleep apnea beyond any normal or other progression. The examiner explained the cause of sleep apnea is not fully understood; however, it does not have a natural progression. She reported the medical condition of sleep apnea remains the same, but CPAP settings are adjusted as needed, especially regarding weight issues in a patient. The examiner explained that although the cause of sleep apnea is not fully understood, it is not medically related to prostate issues, including prostate cancer. She reported these are two entirely separate body systems, the lung and male genitourinary. She reported prostate cancer varies in its course (aggressive in some patients but not in others) and the reasons why are not clear. She reported no current medical evidence links prostate cancer to the development of, or aggravation of sleep apnea. The Board of Veterans’ Appeals (Board) finds the opinions highly probative as they were made by a medical professional with consideration of the specific facts in this case and after examination of the Veteran. The example considered the history in light of current medical knowledge. For example, the examiner explained that the current medical literature does not establish a link between PTSD and sleep apnea, or prostate cancer and sleep apnea. There is no medical opinion or competent and credible evidence in significant conflict with the VA medical opinion. The Board has considered the Veteran’s statements, to include his assertions that sleep apnea is caused or aggravated by his service-connected disabilities. As the Veteran is not shown to have medical education or experience, he is a lay person and is competent to report (1) symptoms that are observable to a layperson, e.g., apnea symptoms; (2) symptoms at the time supporting a later diagnosis by a medical professional; or (3) a contemporaneous medical diagnosis. See Davidson v. Shinseki, 581 F.3d 1313 (2009). The Veteran is not competent to independently render a medical diagnosis or opine as to the specific etiology of a condition as these are medically complex issues. Thus, his lay assertions do not constitute evidence upon which service connection can be granted. The Board acknowledges the Veteran has referenced a July 2016 article entitled “Sleep disturbances in veterans with chronic war-induced PTSD.” However, the article merely addresses that there is an association between veterans with PTSD and sleep disturbance, acknowledging that sleep disturbance is a frequent complaint among persons diagnosed with PTSD. This is in no way in conflict with the examiner’s conclusion or rationale. The Board ultimately assigns greater probative weight to the medical evidence of record specific to this claim, to include the opinion rendered by a trained medical professional based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale. (Continued on the next page) For the above reasons, the preponderance of the evidence is against the claim and service connection is denied. Nathan Kroes Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Gonzalez, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.