Citation Nr: 20004151 Decision Date: 01/16/20 Archive Date: 01/16/20 DOCKET NO. 14-08 485 DATE: January 16, 2020 ORDER Entitlement to service connection for obstructive sleep apnea is granted. FINDING OF FACT Resolving all reasonable doubt in the Veteran’s favor, the Veteran’s obstructive sleep apnea is related to his service-connected hypothyroidism. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea have been met. 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 June 1992 to June 2007. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. In October 2015, the Board remanded this matter for further development. That development having been completed, this matter has returned to the Board for further appellate review. 1. Entitlement to service connection for obstructive sleep apnea Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, to prove service connection there must be: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Service connection may also be established for a disability which is proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310(a). Further, a disability which is aggravated by a service-connected disability may be service-connected to the degree that the aggravation is shown. Allen v. Brown, 7 Vet. App. 439 (1995). The Veteran seeks service connection for obstructive sleep apnea. During the August 2015 Board hearing, the Veteran testified that he began experiencing sleep problems while on active duty. The Veteran also contends that his sleep apnea is caused or aggravated by his service-connected hypothyroidism. As an initial matter, the Veteran has a current diagnosis of obstructive sleep apnea. Thus, the question for the Board is whether the Veteran’s current sleep apnea is related to service or his service-connected disabilities. A review of the Veteran’s service treatment records does not reveal treatment for or a diagnosis of sleep apnea or sleep problems during service. Additionally, the Veteran denied frequent trouble sleeping in a May 2005 report of medical history. Post-service treatment records do not reveal a diagnosis of or treatment for sleep apnea until July 2008, when the Veteran underwent a sleep study and was diagnosed with mild obstructive sleep apnea. A VA medical opinion was obtained in November 2015, at which time the examiner opined that the Veteran’s sleep apnea was less likely than not incurred in or caused by service. The examiner noted that the Veteran’s service treatment records did not reveal evidence of symptoms or a diagnosis of sleep apnea in service. The examiner explained that the symptoms of fatigue and weight gain the Veteran experienced in service are attributable to his service-connected hypothyroidism. Regarding secondary service connection, the Veteran underwent a VA examination in March 2013. The examiner noted the Veteran’s gradual weight gain could not be connected his hypothyroidism, as the hypothyroidism had been relatively well-controlled until recently. The examiner explained that medical literature failed to reveal a causal connection between hypothyroidism and obstructive sleep apnea. As such, the examiner opined that the Veteran’s sleep apnea was less likely than not proximately due to or the result of his service-connected hypothyroidism. In rendering the opinion, the examiner did not address whether the Veteran’s sleep apnea was aggravated beyond natural progression by his service-connected hypothyroidism. In November 2015, a VA examiner opined that the Veteran’s obstructive sleep apnea was not permanently worsened in severity by his service-connected hypothyroidism. The examiner noted that the Veteran’s gradual weight gain is more likely than not the cause of his sleep apnea. The examiner also noted the Veteran suffers from multiple co-morbidities, including hypothyroidism, which lead to weight gain, and the sleep apnea is the result of their combined effects. As such, the examiner explained that the Veteran’s sleep apnea cannot be solely attributed to hypothyroidism as each one of the conditions likely contributes to sleep apnea. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current sleep apnea, at least in part, is related to weight gain attributed to service-connected hypothyroidism. Accordingly, resolving all doubt in the Veteran’s favor, service connection for obstructive sleep apnea, as secondary to his service-connected hypothyroidism is granted. 38 C.F.R. § 3.102. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Lance, Law Clerk 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.