Citation Nr: A19001587 Decision Date: 09/26/19 Archive Date: 09/26/19 DOCKET NO. 190226-2880 DATE: September 26, 2019 ORDER Service connection for obstructive sleep apnea, as secondary to service-connected posttraumatic stress disorder (PTSD) with insomnia disorder, is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran’s obstructive sleep apnea is caused by his service-connected PTSD with insomnia disorder. CONCLUSION OF LAW Resolving reasonable doubt in the Veteran’s favor, the criteria for service connection for obstructive sleep apnea, as secondary to service-connected PTSD with insomnia disorder, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1982 to July 1986 and September 2000 to December 2003. In May 2018, the Veteran selected the Higher-Level Review lane when he opted in to the Appeals Modernization Act (AMA) review system by submitting a Rapid Appeals Modernization Program (RAMP) election form. In a September 2018 RAMP decision, the Agency of Original Jurisdiction (AOJ), in pertinent part, denied service connection for sleep apnea. In the Veteran’s February 2019 VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)), he disagreed with the denial of service connection for sleep apnea and selected the Direct Review lane. Service connection for obstructive sleep apnea. The Veteran claims that his obstructive sleep apnea is secondary to his service-connected PTSD with insomnia disorder. Service connection is warranted for disability proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a), (b). For the reasons below, service connection for sleep apnea, on a secondary basis, is warranted. The medical evidence of record shows current obstructive sleep apnea. See, e.g., VA treatment record dated September 2014. Therefore, a current disability is established. The remaining question is whether the Veteran’s obstructive sleep apnea is caused or aggravated by his service-connected PTSD with insomnia disorder. In a January 2016 letter, Michael K. Nunn, D.O., a Board-certified psychiatrist opined that the Veteran’s service-connected PTSD contributes to or aggravates his sleep apnea. Along with the opinion, Dr. Nunn provided his evaluation report of the Veteran that documented his current sleep apnea and PTSD symptoms. In the evaluation report, Dr. Nunn noted that the “combination of PTSD and sleep apnea generate disturbed sleep.” Also, with the opinion, Dr. Nunn provided a medical article, Association of Psychiatric Disorders and Sleep Apnea in a Large Cohort, that supports a relationship between psychiatric disorders and sleep apnea. The Board finds that the January 2016 opinion is highly probative. Although Dr. Nunn did not provide a rationale following the opinion, it was provided with a medical article that supports a relationship between psychiatric disorders and sleep apnea. Furthermore, Dr. Nunn provided his evaluation report of the Veteran that documented his current sleep apnea and PTSD symptoms. See Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner “did not explicitly lay out the examiner’s journey from the facts to a conclusion,” did not render the examination inadequate); Acevedo v. Shinseki, 25 Vet. App. 286, 294 (2012) (medical reports must be read as a whole and in the context of the evidence of record). In a December 2014 VA examination report, the VA examiner found that the Veteran’s sleep apnea was not secondary to his service-connected PTSD. Similarly, in a March 2017 VA examination report, the VA examiner opined that it is less likely than not that the Veteran’s sleep apnea is proximately due to or the result of his PTSD. (Continued on the next page)   The December 2014 and March 2017 VA examiners did not address Dr. Nunn’s opinion that found that the Veteran’s PTSD contributes to or aggravates his sleep apnea or the medical article that supports a relationship between psychiatric disorders and sleep apnea. Therefore, the Boards find that the December 2014 and March 2017 VA opinions are afforded less probative value. See Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) (the Board may not simply adopt a medical examiner’s opinion that fails to discuss favorable evidence of record but must instead account for that favorable evidence with an adequate statement of reasons or bases). In sum, the Board finds that Dr. Nunn’s opinion outweighs the VA medical opinions, resolving any reasonable doubt in the Veteran’s, service connection is warranted for obstructive sleep apnea. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. James March Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Castillo, 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.