Citation Nr: 20021767 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 14-38 678 DATE: March 26, 2020 ORDER Entitlement to service connection for obstructive sleep apnea (OSA) as due to sinusitis is granted. FINDING OF FACT Resolving reasonable doubt in the Veteran’s favor, his OSA is at least as likely as not related to his service, to include his in-service chronic, sinusitis. CONCLUSION OF LAW The criteria for service connection for OSA are 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 service in the United States Navy from December 1983 to October 1993. The Veteran was afforded a video conference hearing before the undersigned in November 2017. The Board remanded the issue of entitlement to service connection for sleep apnea in March 2018 in order to afford the Veteran a VA examination, which was obtained in October 2019. 1. Entitlement to service connection for obstructive sleep apnea (OSA) as due to sinusitis. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (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). The Veteran contends that he is entitled to service connection for OSA. See July 2013, Application for Disability Compensation and Related Compensation Benefits. The Board concludes that the Veteran has a current disability of OSA that is related to sinusitis experienced in service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). First, the Veteran has a current disability of OSA. See January 2020, VA examination Sleep Apnea Disability Benefits Questionnaire; see also October 2019 VA examination Sleep Apnea Disability Benefits Questionnaire; see also March 2013 Georgia Lung Associates Sleep Disorders Laboratory, Diagnostic Polysomnography. Thus, the question becomes whether the current disability is related to service. On this question there is probative evidence in favor of such a finding. Second, the Veteran experienced symptoms related to chronic sinusitis while in service. Specifically, an April 1988 service treatment note indicated that there was sinusitis, severe and chronic. See April 1988, Service Treatment Record, Radiographic Report. Additional service treatment notes show the Veteran was variously noted to have sinus tenderness, and sinus congestion. Finally, the Board finds a positive nexus opinion between the Veteran’s sleep apnea and sinusitis experienced in service, to be highly probative. Specifically, in October 2019 following examination for his OSA, the VA examiner opined that it is at least as likely as not that the Veteran’s OSA is related to, secondary to his service connected chronic sinusitis, supported by medical literature and clinical studies showing that combat veterans with chronic sinusitis experience significantly higher rates of OSA than do Veterans without sinusitis. See October 2019 Medical Opinion Disability Benefits Questionnaire. The examiner opined that the current OSA and sinusitis were at least as likely as not related because medically there was a pathophysiological relationship between these conditions. The examiner cited to articles to include from the National Institute of Health. The Board observes that VA examination for sinusitis indicated there was a history of chronic sinusitis, although no current findings of sinusitis. See January 2020 VA examination, Sinusitis, Rhinitis and other Conditions of the Nose, Throat, Larynx and Pharynx Disability Benefits Questionnaire. Furthermore, the Board observes that entitlement to service connection for sinusitis has not been adjudicated, and is not service connected. Accordingly, the Board finds that the October 2019 examiner was relating the Veteran’s current OSA to his history of sinusitis, which occurred in-service, such that there is a positive nexus to service. This is supported by the record showing service treatment reports for sinusitis, sinus congestion and sinus tenderness. (Continued on the next page)   There are no negative nexus opinions to the contrary. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current OSA is related to service, to include his sinusitis experienced in service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for OSA is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Barner, 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.