Citation Nr: 20021048 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 18-34 204 DATE: March 24, 2020 ORDER Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected disabilities, is denied. FINDING OF FACT The Veteran’s obstructive sleep apnea was not incurred or aggravated as secondary to service-connected disabilities, and is not otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for service connection for obstructive sleep apnea due to service or service-connected disabilities are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active military service from November 1981 to February 1982 and from May 1984 to October 2008. This matter is on appeal from a November 2016 rating decision and was previously remanded by the Board of Veterans’ Appeals (Board) in June 2019. The Veteran contends that he has obstructive sleep apnea that is secondary to his service-connected disabilities of posttraumatic stress disorder (PTSD), low back, right knee, right elbow, right shoulder, left ankle, right thumb arthritis, tinnitus, left ear hearing loss, left ear otitis media, and/or allergic rhinitis. See, e.g., February 2017 representative’s argument. Because the Veteran has not raised, and the record does not reasonably raise, entitlement to direct service connection, the Board’s adjudication will consider only entitlement to secondary service connection. In this regard, a sleep study performed during service in May 2008 was negative, and a December 2019 VA examiner provided a negative opinion based on the 2008 sleep study. Service connection may be granted for a disability that is proximately due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310. The question for the Board is whether the Veteran has a current disability that is proximately due to or the result of, or is aggravated beyond its natural progress by service-connected disability. The Board concludes that, while the Veteran has a current diagnosis of obstructive sleep apnea, the preponderance of the evidence is against finding that it is proximately due to or the result of, or aggravated beyond its natural progression by service-connected disabilities. 38 U.S.C. §§ 1110, 1131; Allen v. Brown, 7 Vet. App. 439 (1995) (en banc); 38 C.F.R. § 3.310(a). The November 2016 VA examiner opined that the Veteran’s obstructive sleep apnea is less likely than not proximately due to or the result of the service-connected PTSD. The rationale was that the Veteran had been having PTSD symptoms since early 2008 after returning from deployment to Iraq in January 2008, and was therefore present when the Veteran had his initial sleep study in May 2008, which was negative for sleep apnea. The examiner explained that the Veteran's sleep apnea is less likely as not due to PTSD because his initial sleep study done after onset of PTSD symptoms was negative for sleep apnea. The examiner further opined that the Veteran's most likely cause of sleep apnea was age related changes as he was diagnosed with sleep apnea at the age of 55 years on a sleep study done seven years after the initial sleep study. They noted that it was widely reported within the medical literature that sleep apnea is a common condition in older individuals within all populations and its incidence increases with age. The examiner referred to information from the National Heart, Lung, and Blood Institute and a medical article in support of that opinion. A January 2020 VA examiner opined that the Veteran's sleep apnea is less likely than not proximately due to or aggravated beyond its natural progression by the Veteran's service-connected disabilities (PTSD, low back, right knee, right elbow, right shoulder, left ankle, right thumb arthritis, tinnitus, left ear hearing loss, left ear otitis media, and/or allergic rhinitis). The rationale was that sleep apnea has many different possible causes. They noted that in adults, the most common cause of sleep apnea is excess weight and obesity, which is associated with soft tissue of the mouth and throat. They explained that during sleep, when throat and tongue muscles are more relaxed, this soft tissue can cause the airway to become blocked. The examiner opined that sleep apnea is not related nor aggravated to any other disabilities, such as those for which the Veteran is service connected. They referred to a medical article in support of their opinion. Taken together, the Board finds the examiners’ opinions probative, because they are based on an accurate medical history and provide explanations that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). The Veteran submitted private opinions from his representative, who is also a physician, dated in July 2016 and from another physician dated in June 2018. Both of these opinions show that the Veteran's sleep apnea is caused and/or aggravated by the service-connected PTSD, allergic rhinitis, tinnitus, and chronic pain from the orthopedic disabilities. The 2018 opinion shows that while each of the Veteran's disabilities solely is sufficient to cause obstructive sleep apnea, clearly a combination of those disabilities will cause obstructive sleep apnea. Both opinions refer to medical literature supporting relationships between sleep apnea and those disabilities. However, the opinions are not specific to this Veteran, but are general in nature. Further, the medical literature cited to in these opinions suggest that there are higher incidences of sleep apnea in people with PTSD; inefficient nasal breathing (such as that caused by rhinitis) affects upper airway resistance during sleep; and sleep disturbance is common among tinnitus sufferers and those with chronic pain. The medical literature referred to in those opinions does not show that those disabilities cause sleep apnea, or that they aggravate it beyond its natural progression. More specifically, it does not show that this particular Veteran’s PTSD, allergic rhinitis, tinnitus, and orthopedic disabilities caused or aggravate his obstructive sleep apnea beyond its natural progression. Consequently, the Board accords them limited probative value. The Veteran believes his obstructive sleep apnea is proximately due to or the result of/aggravated beyond its natural progression by service-connected disabilities. The Veteran in this case is not competent to provide a nexus opinion regarding this issue because the record does not show that he has the skills or medical training to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the VA examiners’ opinions failing to show a relationship between obstructive sleep apnea and the Veteran's service-connected disabilities, and this appeal must be denied. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Barstow, 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.