Citation Nr: 20022040 Decision Date: 03/30/20 Archive Date: 03/30/20 DOCKET NO. 15-39 495 DATE: March 30, 2020 ORDER Service connection for sleep apnea is granted. FINDING OF FACT Sleep apnea is caused or aggravated by a service-connected psychiatric disability. CONCLUSION OF LAW The criteria for service connection for sleep apnea are met. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from March 2006 to July 2010, including foreign service in Afghanistan and Iraq. For his meritorious service, he was awarded (among other decorations) the Afghanistan Campaign Medal with Campaign Star, the Iraq Campaign Medal with Campaign Star, and the Combat Infantryman Badge. The Veteran testified as to this matter during a February 2019 videoconference hearing. A transcript of this proceeding has been associated with the record. This appeal was then remanded by the Board in June 2019 for additional development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Service Connection The Veteran now continues his appeal seeking service connection for sleep apnea. A review of the record indicates that the Veteran has offered multiple theories of entitlement, to include direct service connection or as secondarily related to nonservice-connected rhinitis. As this appeal is granted on a separate basis, the Board declines to further assess these theories herein. Rather, this analysis will focus on the Veteran’s contention that the claimed disorder is related to his service-connected posttraumatic stress disorder (PTSD). Thus, service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310. Allen v. Brown, 7 Vet. App. 439 (1995). To establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998). Here, the Veteran was diagnosed with obstructive sleep apnea following June 2013 private sleep study. This diagnosis was confirmed in a February 2019 private treatment letter, and it is additionally noted throughout VA treatment records spanning the period on appeal. Accordingly, the first element of secondary service connection has been met. With respect to the second element, the Veteran is currently service-connected for PTSD. See December 2013 rating decision. As such, this appeal may be granted upon competent evidence of a causal nexus between the two conditions. There are conflicting opinions of record in this regard. Notably, the February 2019 private physician offered a positive opinion, concluding that the Veteran’s PTSD interfered with his sleep and caused central sleep apnea, which in turn aggravated his obstructive sleep apnea. In doing so, the physician provided a detailed review of the Veteran’s physical systems, his military history, and the nature and severity of his current symptoms. In contrast, a January 2020 Disability Benefits Questionnaire (DBQ) indicates that the Veteran’s sleep apnea is less likely than not due to or a result of his service-connected psychiatric disability. Here, the physician indicated that the two conditions are not medically related, and medical literature does not support the finding of a relationship between the two conditions in the “vast majority” of cases. Instead, sleep apnea is caused by an anatomical condition, which is not caused by PTSD. Accordingly, no causality was established. Upon comparison of the above, greater probative value is afforded to the positive February 2019 opinion in concluding that a nexus is present in this case. Notably, the February 2019 opinion was based upon contemporaneous examination of the Veteran and a detailed assessment as to the nature and severity of his current symptoms. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that the probative value of a medical opinion comes from the “factually accurate, fully articulated, sound reasoning for the conclusion”). Moreover, the January 2020 opinion exhibits several critical flaws. Importantly, this opinion is limited only to whether the Veteran’s PTSD causes his sleep apnea, such that an opinion as to aggravation is entirely absent. Further, the examiner clearly notes that “an association with PTSD” and sleep apnea has been reported, but fails to address why such a link is not present in the instant case. The Board acknowledges that, in its previous decision, it found the private opinion submitted by the Veteran to be inadequate. From a practical standpoint, however, the adequacy of the examination and opinion cannot be viewed in a vacuum. When weighed against the VA opinion of record, the relative strengths of the private opinion are much more apparent. The Board declines to remand for potentially negative evidence. Rather, given the competency of the February 2019 opinion versus the deficiencies of the January 2020 opinion, it is found that the preponderance of the evidence weighs in favor of the appeal. Accordingly, service connection for sleep apnea is hereby granted on a secondary basis. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Kovarovic, 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.