Citation Nr: 20007977 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 17-17 449 DATE: January 30, 2020 ORDER Entitlement to service connection for obstructive sleep apnea is granted. FINDING OF FACT The Veteran’s obstructive sleep apnea is related to her service. CONCLUSION OF LAW The criteria for entitlement to service connection for obstructive sleep apnea have been met. 38 U.S.C. §§ 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1980 to November 1984. She contends that her currently diagnosed obstructive sleep apnea, although not diagnosed until later, began in service, and is aggravated by her service-connected posttraumatic stress disorder (PTSD). Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). Additionally, service connection may be granted, on a secondary basis, for a disability which is proximately due to or the result of an established service-connected disorder. 38 C.F.R. § 3.310. Similarly, any increase in severity of a non-service-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the non-service-connected disease, will be service-connected. Allen v. Brown, 7 Vet. App. 439 (1995). In the latter instance, the non-service-connected disease or injury is said to have been aggravated by the service-connected disease or injury. 38 C.F.R. § 3.310. To establish service connection, there must be a competent diagnosis of a current disability; medical or, in certain cases, lay evidence of in-service occurrence or aggravation of a disease or injury; and competent evidence of a nexus between an in-service injury or disease and the current disability. Hickson v. West, 12 Vet. App. 247, 252 (1999); see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Veteran has consistently reported that when she was in service her roommates would complain that she snored very loudly. She also reported that during service her spouse would wake her up and tell her she had stopped breathing. He also complained of her snoring. The Veteran reported that she was treated for tonsillitis in service and eventually underwent a uvulectomy and tonsillectomy, but her sleep problems did not resolve. The record reflects that the Veteran was first diagnosed with obstructive sleep apnea in 2009. In July 2013, the Veteran underwent a VA examination. The examiner noted that the Veteran’s service treatment records reflect diagnoses of recurrent acute tonsillitis in service but opined that the Veteran’s tonsillitis did not cause her sleep apnea as the record does not reflect that the Veteran developed sleeping problems or permanently enlarged tonsils or adenoids. The examiner did not address the Veteran’s report that she has had her tonsils removed. In a 2013 treatment record, the Veteran’s treating pulmonologist stated that the Veteran reported irregular snoring and daytime hypersomnolence in 1984 prior to her discharge from service. He stated that it is certainly conceivable that the Veteran’s sleep apnea could have been present at that time, but no testing was available at that time. In a May 2018 letter, he also stated that there is no question that the Veteran’s service-connected PTSD can aggravate her sleep apnea. In a May 2018 letter, the Veteran’s treating psychologist opined that it is reasonable that the Veteran’s PTSD has aggravated her sleep apnea, explaining that research literature suggests a bidirectional relationship between the two conditions, including that elevated stress hormones as a result of PTSD may exacerbate sleep apnea. The Board finds the Veteran’s report of experiencing sleep troubles and being told she snored and stopped breathing during sleep in service to be competent and credible. The Board finds the opinion of the VA examiner to have little probative weight as it only discusses whether the Veteran’s tonsillitis caused her sleep apnea and does not address the Veteran’s report that her sleep problems began in service and continued after the removal of her tonsils. (Continued on the next page)   Giving the Veteran the benefit of the doubt, the Board finds that service connection for obstructive sleep apnea is warranted. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Christensen 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.