Citation Nr: 20004792 Decision Date: 01/21/20 Archive Date: 01/21/20 DOCKET NO. 19-09 270 DATE: January 21, 2020 ORDER Entitlement to service connection for sleep apnea, claimed as secondary to service-connected posttraumatic stress disorder (PTSD), is granted. FINDING OF FACT The Veteran’s sleep apnea is proximately due to his service-connected PTSD. CONCLUSION OF LAW The criteria for service connection for sleep apnea as secondary to PTSD have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from April 1988 to August 1991, to include service in Iraq. For his meritorious service the Veteran was awarded the Army Achievement Medal and the Southwest Asia Service Medal, among other decorations. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in September 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for sleep apnea as secondary to PTSD The Veteran is seeking service connection for sleep apnea as secondary to PTSD asserting, among other contentions, that the medication prescribed for his PTSD is the proximate cause of his sleep apnea. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Further, service connection may not be awarded on the basis of aggravation without establishing a pre-aggravation baseline level of disability and comparing it to the current level of disability. 38 C.F.R. § 3.310 (b). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Currently, the Veteran is service connected for PTSD and is taking medications for said disorder. The Veteran asserts that the medication that he is taking for his PTSD contributed to his obesity which is the underlying cause of his sleep apnea. In August 2015, the Veteran underwent a VA examination to determine the nature and etiology of his sleep apnea and its relation to the Veteran’s PTSD. The examining physician opined that while PTSD itself is not considered a risk factor for sleep apnea, there are several related conditions that can result in sleep apnea. He further opined that medication used for PTSD, has been reported to cause obesity, which can aggravate or cause sleep apnea. The examiner determined that it was at least as likely as not that the Veteran’s sleep apnea was proximately due to his service-connected PTSD. The Veteran submitted a September 2016 letter from a private physician addressing the relationship between the Veteran’s PTSD and his sleep apnea. In this letter, the physician explained that a known side effect of the medication the Veteran is taking for PTSD is weight gain. The physician further detailed the relationship between obesity and sleep apnea stating that obesity is a high risk factor for obstructive sleep apnea. The physician opined that it is more likely than not that the Veteran’s sleep apnea is related to and aggravated by his service-connected PTSD. Another letter from a private physician in August 2019 stated that it is well documented that PTSD predisposes an individual to weight gain even without the use of medication. The physician then explained that sleep apnea is intimately linked to obesity. Thus, the physician opined that it is at least as likely as not that the Veteran’s current obstructive sleep apnea is secondary to and aggravated by his service-connected PTSD. The Board finds that the August 2015 VA examiner's opinion, as well as the September 2016 and August 2019 private medical opinions are entitled to great probative weight as such considered all of the pertinent evidence of record, to include the statements of the Veteran, and provided a complete rationale, relying on and citing to the records reviewed. Moreover, the examiners offered clear conclusions with supporting data as well as reasoned medical explanations connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Further, there is no medical opinion to the contrary of record. Accordingly, the Board finds that a relationship exists between the Veteran’s sleep apnea and his service-connected PTSD. As such, secondary service connection for sleep apnea is warranted. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. K. Hall, 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.