Citation Nr: 20008071 Decision Date: 01/30/20 Archive Date: 01/30/20 DOCKET NO. 17-02 933 DATE: January 30, 2020 ORDER Entitlement to service connection for obstructive sleep apnea is denied. FINDING OF FACT The Veteran’s obstructive sleep apnea did not manifest during active service; and there is no indication that it is causally related to his active service. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active naval service from June 1990 to October 2011. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision issued by a Region Office (RO) of the Department of Veterans Affairs (VA). Service Connection – Sleep Apnea The Veteran has asserted that he has sleep apnea that is the result of his active service. The Veteran’s service treatment records indicated that he complained of problems sleeping or still feeling tired after sleeping on his September 2006 post-deployment assessment. In February 2009, he was seen for complaints of a sleeping disorder. He reported experiencing anxiety associated with job changes and family separation. He stated that he was not sleeping more than usual. He stated that he would awake in the middle of the night most nights and would stay awake for an hour. It was noted that he did not have sleep apnea. The diagnosis was primary idiopathic insomnia and given Ambien. In November 2010, he reported that he was waking up several times during the night and had trouble falling asleep. It was noted that he had a long history of snoring and daytime sleepiness. Ambien was continued and a sleep study was ordered. The report of a December 2010 sleep study indicated that the Veteran did not present with features of sleep apnea. It was noted that he had significant spontaneous arousals and it was suggested that hypnotic/anti-anxiety type medication be tried first and that if daytime fatigue had not resolved, other causes should be considered. In March 2011, sleep hygiene was discussed with the Veteran and Ambien was continued. Post-service, the Veteran continued to be treated for insomnia. In May 2015, it was noted that he had chronic insomnia and restless sleep pattern. Another sleep study was ordered. The report of a May 2015 sleep study indicated that the Veteran had obstructive sleep apnea with moderately severe sleep fragmentation and minimal associated oxygen desaturations. Another July 2015 sleep study report noted findings consistent with sleep apnea. In December 2015, the Agency of Original Jurisdiction (AOJ) obtained a VA medical opinion. The VA examiner opined that it was less likely than not that the Veteran’s sleep apnea was incurred in or caused by service. The examiner noted that the Veteran had a sleep study done during service in December 2010, and that those results, including an apnea-hypopnea index (AHI) of 0.3, were not consistent with a diagnosis of obstructive sleep apnea. The examiner also noted that a January 2013 treatment record indicated that the Veteran had a diagnosis of insomnia that responded well to Lunesta. The examiner noted that there was no interval history of deviated nasal septum or other problem/risk factor for the development of obstructive sleep apnea while in severe that could have led to the development of obstructive sleep apnea after retirement and that it was less likely that his sleep apnea condition developed due to his insomnia. The Board notes that the Veteran is service-connected for posttraumatic stress disorder (PTSD) and insomnia. In this case, the Board finds the most probative evidence weighs against the claim. Although the Veteran had sleep difficulties during service and was diagnosed with insomnia, a sleep study in December 2010 indicated that he did not have obstructive sleep apnea at that time. Obstructive sleep apnea was not diagnosed until May 2015, over three year after he retired from service. In addition, the December 2015 VA examiner opined that it was less likely than not obstructive sleep apnea was incurred in or otherwise related to the Veteran’s service. The VA examiner based his opinion on the relevant medical evidence and lay statements, and he provided rationale for his opinion. Therefore, the Board finds that VA examiner’s opinion significantly probative. Furthermore, there is no medical opinion to the contrary. Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced. However, the ultimate questions of diagnosis and etiology in this case extends beyond an immediately observable cause-and-effect relationship and are beyond the competence of lay witnesses. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for obstructive sleep apnea is not warranted. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Mishalanie, 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.