Citation Nr: 19152154 Decision Date: 07/05/19 Archive Date: 07/05/19 DOCKET NO. 1610210 DATE: July 5, 2019 ORDER Service connection for rheumatoid arthritis is granted. Service connection for sleep apnea is granted.   FINDINGS OF FACT 1. The Veteran’s rheumatoid arthritis had its onset during the Veteran’s active service. 2. The Veteran’s sleep apnea had its onset during the Veteran’s active service. CONCLUSIONS OF LAW 1. The criteria for service connection for rheumatoid arthritis have been met. 38 U.S.C. § §§ 1110, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303. 2. The criteria for service connection for sleep apnea have been met. 38 U.S.C. § §§ 1110, 1131, 5107; 38 C.F.R. § §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Air Force from January 1987 to October 1991. He also served in the Air National Guard, with verified periods of active service from February 2003 to June 2003, and from August 2006 to October 2006. The case is on appeal from an August 2013 rating decision. In March 2019, the Veteran testified at a Board hearing, at which time the record was held open for 60 days so that the Veteran could procure and submit additional evidence in support of his claims. The additional evidence received since then has been considered as part of this decision. See 38 U.S.C. § § 7105(e); 38 C.F.R. § § § 20.1304(c). Legal Criteria 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. A veteran seeking compensation under these provisions must establish three elements: “(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.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Analysis 1. Service connection for rheumatoid arthritis. The Veteran contends that his rheumatoid arthritis began during his active duty. At his March 2019 Board hearing he testified that he started noticing joint pain symptoms in approximately 2006, that would last for a couple of weeks at a time, and then he would not think about it. He states that in 2008 he started experiencing major symptoms, and was referred to an orthopedic surgeon for suspicion of a torn meniscus. However, after undergoing a knee scoping procedure, there was not a torn meniscus but rather arthritis, and he was referred to a rheumatologist. The Veteran’s service treatment records (STRs) are silent as to complaints or treatment of arthritis, or symptoms of arthritis. Post-active service medical records note the knee surgery orthopedic scope, and a subsequent diagnosis of rheumatoid arthritis in March 2010. Then in February 2011, the Veteran was medically disqualified for “worldwide duty” in part due to his arthritis. The Veteran was not afforded a VA examination in conjunction with his arthritis claim. In April 2019, the Veteran submitted a medical opinion from his private rheumatologist. The physician stated that the Veteran “has suffered with rheumatoid arthritis for nearly a decade,” and “he now suffers with muscle and joint pain that is at least as likely as not (50/50 probability) caused by or a result of his service.” Thus, the record includes a positive medical opinion as to the nexus element of the claim. The Board finds the April 2019 opinion of the rheumatologist persuasive given his review of the file, area of specialty, and full consideration of the lay statements. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Given the totality of the evidence of record, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that he currently has rheumatoid arthritis that had its onset during service. See 38 U.S.C. § § 5107(b); 38 C.F.R. § § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Accordingly, service connection is warranted for rheumatoid arthritis. 2. Service connection for sleep apnea. The Veteran contends that his sleep apnea began during his active duty. At his March 2019 Board hearing, he testified that his wife first noticed that he was snoring badly, and then while deployed in 2003 he was feeling “extremely tired, like I was just walking around in a fog, or just couldn’t concentrate.” The Veteran states he thought it was related to being in a war zone, but when he returned stateside he still noticed the symptoms. After listening to a doctor on a radio show discuss sleep apnea, the Veteran questioned whether he might have the disorder given his symptoms. Thereafter, he was referred to a sleep specialist and diagnosed with sleep apnea in December 2009. The Veteran’s STRs are silent as to complaints or treatment of a sleeping problem. Post-active service medical records note the diagnosis of obstructive sleep apnea in December 2010. Then in February 2011 the Veteran was medically disqualified for “worldwide duty” in part due to his sleep apnea. The Veteran was not afforded a VA examination in conjunction with his sleep apnea claim. In May 2019, he submitted a medical opinion from his private doctor. The physician stated that the Veteran had been under his care since 2002, and that he had reviewed the medical records and was familiar with his medical history. The doctor then opined that it was his “medical opinion that [the Veteran’s] sleep disturbance is at least as likely as not (50/50 probability) a result of his military service in the Persian Gulf War.” Thus, the record includes a positive medical opinion as to the nexus element of the claim. The Board finds the May 2019 opinion of the private physician persuasive given his careful review of the file, area of specialty, and full consideration of the lay statements. See Nieves-Rodriguez, 22 Vet. App. at 295. Given the totality of the evidence of record, and resolving all reasonable doubt in the Veteran’s favor, the Board finds that he currently has sleep apnea that had its onset during service. See 38 U.S.C. § § 5107(b); 38 C.F.R. § § 3.102; Gilbert, 1 Vet. App. at 49. Accordingly, service connection is warranted for sleep apnea. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morford, 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.