Citation Nr: 19158332 Decision Date: 07/26/19 Archive Date: 07/26/19 DOCKET NO. 1845905 DATE: July 26, 2019 ORDER Service connection for sleep apnea, based on secondary aggravation to service-connected gastroesophageal reflux disease (GERD), is granted. FINDING OF FACT The Veteran’s sleep apnea is aggravated by his service-connected GERD. CONCLUSION OF LAW The criteria for service connection for sleep apnea, based on secondary aggravation, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from May 1994 to September 2001. This case is on appeal from an October 2017 rating decision. Service connection for sleep apnea, as secondary to service-connected gastroesophageal reflux disease. 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; 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)). Service connection may also be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. See 38 C.F.R. § 3.310. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 4 (1990). Analysis The Veteran contends he has sleep apnea secondary to service-connected GERD. Medical records from January 2012 include a private medical opinion from a sleep study, during which the Veteran was diagnosed with obstructive sleep apnea (OSA). Additionally, the opinion included a resource article from the National Institute of Health. The article provides that OSA often coexists with GERD and may disrupt sleep, but it is unknown whether GERD reduces sleep quality independently of OSA. Additional medical records from October 2016 include a medical opinion from a VA Chief Medical Officer, stating, “In addition, his GERD has greatly affected his lifestyle…This also causes him to have difficulty with his sleep cycle which greatly affects his sleep apnea. In my opinion, it is more likely than not that his GERD is progressing and that his sleep apnea has worsened because of his GERD. The medical records also include a June 2017 assessment noting the Veteran’s use of a CPAP machine for his sleep apnea. An October 2017 VA opinion indicates it is less likely than not that the Veteran’s OSA is proximately due to or aggravated beyond natural progression by his GERD due to a lack of pathophysiologic relationship between OSA and GERD. Further, the examiner noted she was “unable to locate peer reviewed studies indicating that GERD would actually cause” OSA. A June 2018 VA examination and opinion noted that a symptom of GERD is sleep disturbances. The Board finds the January 2012 information and October 2016 VA opinion persuasive as to secondary aggravation nexus, at least to an equipoise standard. When reasonable doubt is resolved in the Veteran’s favor, the Board finds that the Veteran’s OSA is aggravated by his service-connected GERD. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, the Board concludes that service connection for sleep apnea is warranted on a secondary aggravation basis. The Board notes that 38 C.F.R. § 3.310(b) contemplates a baseline to assess the severity of a nonservice-connected disability that is aggravated by a service-connected disability. However, the Board determines that this is more akin to a downstream rating aspect of the claim that should be addressed in the first instance by the RO following implementation of the instant decision. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becton, 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.